VP, Payment Integrity

A Little More About The Role

The VP of Payment Integrity is responsible for the leadership, strategy, and performance of Gravie’s payment integrity function, ensuring claims are paid accurately and in compliance with all applicable policies. This role will be responsible for driving the strategy for our pre- and post-pay payment integrity programs, including vendor and internal solutions, and building and leading a high performing team to execute on our strategy.

This leader will partner closely with Claims, Network, Product, Technology, Finance, Clinical, Legal/Compliance, and external partners to continuously improve claims payment outcomes, drive plan affordability, and enable Gravie’s growth strategy.

You Will Lead

• payment integrity strategy and execution, including pre- and post-payment reviews, fraud, waste, and abuse (FWA) prevention, and recovery efforts
• design and lead solutions to address leakage throughout the claims lifecycle, including developing internal capabilities and implementing external vendor programs
• assess the current payment integrity program ecosystem and prioritize opportunities to deliver additional savings
• build and manage a high-performing multi-vendor portfolio, enforcing rigorous SLAs and optimizing contingency fee structures to maximize financial yields while actively mitigating provider abrasion
• provide executive leadership over all payment integrity operations, ensuring high performance of all internal and external PI programs
• lead strategy and execution to insource payment integrity opportunities as appropriate
• develop, scale and optimize payment integrity operations to support business growth, new products, and regulatory requirements
• partner with Finance and Med Econ to ensure detailed savings tracking of payment integrity initiatives
• build, mentor, and lead a high-performing leadership team with a strong culture of accountability, collaboration, and continuous improvement
• build strong leadership and career pathways within the organization to support retention and succession planning

A Little More About Us

We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.

We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.

Our clients love us. Customer satisfaction rates among employees using Gravie health plans consistently rank above 80% – nearly 40 points above the industry average.

Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at Gravie care deeply about making a positive impact in the lives of the people we serve.

Benefits

• alternative medicine coverage
• flexible PTO
• up to 16 weeks paid parental leave
• paid holidays
• a 401k program
• transportation perks
• education reimbursement
• 2 days of paid paw-ternity leave

Compensation Range

$207K - $304K