Senior Manager, Payment Integrity COE Rework & Escalations

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience. The Senior Manager, Payment Integrity COE Rework & Escalations provides centralized program leadership for the intake, tracking, coordination, reporting, and resolution of rework and escalations across the Payment Integrity Center of Excellence. Rework & Escalation Portfolio Management Own the centralized portfolio of Payment Integrity rework items and escalations, including intake, categorization, prioritization, status management, aging, dependencies, risks, decisions, and closure evidence. Maintain a consistent source of truth for active work, ensuring each item has a defined business owner, accountable action owner, target date, current status, next step, and escalation path. Coordinate multiple concurrent workstreams and follow up on commitments to sustain momentum, remove barriers, and prevent unresolved items from becoming operational risks. Establish criteria and working norms for intake, triage, prioritization, handoffs, escalation, closure, and post-implementation monitoring. Cross-Functional Coordination & Issue Resolution Lead structured working sessions with business and technical partners to clarify the issue, scope, impact, root cause, interim controls, corrective actions, and decision needs. Connect the appropriate stakeholders across functional boundaries and coordinate activities when resolution requires multiple teams, vendors, systems, or processes. Identify stalled work, conflicting priorities, unclear ownership, resource constraints, and unresolved dependencies; elevate decision points with clear options and recommendations. Support sensitive or high-impact escalations with disciplined documentation, neutral facilitation, and timely communication. Reporting, Metrics & Executive Visibility Develop and maintain recurring dashboards, scorecards, portfolio summaries, aging reports, risk views, and leadership updates for rework and escalation activity. Define meaningful measures for intake volume, backlog, aging, cycle time, on-time actions, closure rate, recurrence, financial or operational impact, and other agreed performance indicators. Synthesize detailed updates into concise, decision-ready reporting that highlights progress, emerging trends, exceptions, risks, required decisions, and accountable owners. Ensure reporting definitions, data sources, status criteria, and calculation methods are documented and applied consistently. Root Cause, Corrective Action & Rework Reduction Partner with operational owners and subject matter experts to document root causes, contributing factors, failure points, and control gaps using practical process-improvement methods. Track corrective and preventive actions through implementation, validation, and sustained closure rather than administrative completion alone. Analyze patterns across rework and escalation activity to identify repeat drivers, systemic issues, high-friction handoffs, and opportunities for standardization or automation. Translate lessons learned into process, training, control, communication, governance, or technology recommendations. Governance & Operating Rhythm Design and facilitate a tiered governance cadence for working teams, functional leaders, and executive stakeholders, with clear agendas, pre-reads, decisions, actions, and follow-up. Maintain decision logs, action registers, risk and issue logs, milestone plans, and escalation records with appropriate version control and auditability. Develop standard templates, definitions, workflows, and job aids that improve consistency across the PI COE rework and escalation lifecycle. Promote accountability through transparent reporting, timely follow-up, defined service expectations, and fact-based escalation. Stakeholder Communication & Change Enablement Build trusted partnerships with leaders, process owners, analysts, project teams, and external partners involved in rework