• Provide strategic leadership for the Audit Programs function within Payment Integrity. • Lead the design, execution, and continuous optimization of prepayment and post payment audit programs that improve claims accuracy, reduce improper payments, and strengthen payment controls across all applicable lines of business. • Establish the audit program roadmap, governance, methodologies, and performance standards; oversee internal teams and external partners; and partner across the enterprise to implement solutions that deliver sustainable medical cost savings and operational excellence. • Provide strategic leadership for enterprise payment integrity audit programs, including prepayment and post payment audits. • Design, implement, and continuously improve audit strategies, methodologies, and governance standards. • Oversee clinical, coding, pricing, and policy audit activities to reduce improper payments and improve claims accuracy. • Lead the identification, prioritization, and execution of audit opportunities aligned with financial and operational goals. • Establish performance standards, metrics, and reporting to monitor audit effectiveness, savings, and operational health. • Leverage data and analytics to identify trends, risks, and root causes of payment errors. • Partner with Claims, Clinical, Finance, Compliance, Legal, Provider Relations, and Technology teams to resolve issues and improve processes. • Serve as a senior escalation point for complex audit findings, provider disputes, and operational challenges. • Oversee external vendors supporting audit and recovery activities, ensuring quality, compliance, and performance accountability. • Communicate audit results, risks, and recommendations clearly to senior leadership. • Lead, develop, and mentor audit and clinical teams, fostering a culture of accountability and continuous improvement. • Performs other duties as assigned. • Complies with all policies and standards.