Vice President, Payment Integrity
Core
Senior executive accountable for enterprise Payment Integrity function, driving payment accuracy, affordability, and medical cost performance through strategy, vendor management, and program leadership.
Role type
VP, Payment Integrity (Strategy & Operations)
Builds
Enterprise payment integrity ecosystem (prepay/postpay programs, vendor partnerships, analytics)
Domain
Health Insurance / Payer Operations / Financial Integrity
Required skills
Strategic planning, Financial acumen, Vendor management, Data analytics, Regulatory compliance, Cross-functional leadership, Program governance, Cost optimization, Stakeholder management, Change management
Preferred skills
AI/ML strategy, Sourcing expertise, Provider relations, Analytics strategy
Technologies
AI, machine learning, automation, claims configuration systems, data analytics platforms
Responsibilities
Develop and execute multi-year Payment Integrity strategy and roadmap; Lead vendor portfolio management and sourcing strategy; Oversee prepay and postpay program performance; Define data and analytics standards for savings validation; Establish executive performance frameworks and governance models; Partner with Finance, Network, and Claims Operations to drive payment accuracy.
Seniority
Executive (VP level)
