VP, Payment Integrity
Core
Lead the strategy and execution of payment integrity programs to ensure accurate claims payment and compliance, driving savings and operational efficiency.
Role type
VP of Payment Integrity (Executive Leadership)
Builds
Pre- and post-pay payment integrity programs, internal capabilities, and external vendor solutions for healthcare claims.
Domain
Healthcare / Insurance / Claims Operations
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Payment integrity strategy, fraud waste and abuse prevention, claims lifecycle management, vendor portfolio management, regulatory compliance, financial acumen, team leadership, operational scaling
Preferred skills
In-sourcing strategies, KPI development, succession planning, stakeholder partnership
Technologies
None explicitly stated
Responsibilities
Lead payment integrity strategy and execution including FWA prevention; Design solutions to address leakage in the claims lifecycle; Build and manage a multi-vendor portfolio; Provide executive leadership over all payment integrity operations; Establish and monitor savings and operational KPIs; Build and mentor a high-performing leadership team
Seniority
VP, Executive Leadership