Job Title: Director of Program Integrity Location: Dallas, TX Employment Type: Full-Time, Onsite Overview We are seeking an experienced Director of Program Integrity to lead and oversee the operations of the Program Integrity department, with a focus on claims editing, fraud/waste/abuse (FWA) prevention, and payment accuracy . This role will play a critical part in supporting the health plan’s commitment to operational excellence, cost containment, and compliance with state and federal requirements. Key Responsibilities Provide strategic leadership and operational oversight for the Program Integrity department.

Identify and improve work processes, job designs, and workflows to increase efficiency and effectiveness.

Stay current on industry trends, regulations, and accreditation requirements; integrate best practices into department operations.

Ensure adherence to all applicable laws, policies, and guidelines while maintaining effective internal controls.

Develop and manage departmental budgets to support operational goals.

Establish and monitor annual goals and objectives aligned with the organization’s mission.

Select, train, and manage staff, fostering professional growth and maximizing individual and team performance.

Lead major organizational initiatives, driving measurable outcomes and improvements in payment integrity and compliance.

Required Skills & Abilities Excellent verbal and written communication skills with the ability to articulate complex information clearly.

Strong interpersonal, coaching, and conflict resolution skills.

Strategic thinker with proven ability to lead organizational initiatives and achieve results.

Ability to manage competing priorities in a fast-paced environment.

Strong analytical and problem-solving skills.

In-depth knowledge of Texas Medicaid (STAR, STAR Kids, CHIP), NCQA standards, and managed care regulations .

Proficiency in Microsoft Office Suite and related technology tools.

Demonstrated leadership experience in program integrity, claims, compliance, or related healthcare operations.

Qualifications Experience with fraud, waste, and abuse detection/prevention in managed care.

Background in Medicaid/CHIP or health plan operations leadership.

Proven ability to build and lead high-performing teams in complex healthcare environments.

#J-18808-Ljbffr