VP, Payment Integrity

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🕒 Junho 25

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Gravie

SiteLinkedInTodas as Vagas

51 - 200 funcionários

🏥 Saúde

💼 Consultoria

🍽️ Alimentos e Bebidas

Healthcare • Consulting • Food & Beverage

Gravie é uma empresa especializada em oferecer soluções inovadoras de benefícios de saúde e seguros. Suas ofertas incluem o plano de saúde Comfort, que simplifica a cobertura de saúde sem franquias e zero copays em serviços comuns de saúde. A Gravie também fornece Arranjos de Reembolso de Saúde de Cobertura Individual (ICHRA) e Gravie Pay, um sistema de suporte para gerenciar custos de saúde. A empresa enfatiza benefícios claros e diretos que facilitam o cuidado preventivo e reduzem despesas inesperadas de saúde, atendendo tanto a membros individuais quanto a pequenas e médias empresas. A Gravie visa tornar os benefícios de saúde acessíveis, compreensíveis e econômicos para empregadores e empregados.

Descrição

• 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 • Establish and monitor savings and operational KPIs • 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

🎯 Requisitos

• 15+ years of progressive leadership experience in healthcare claims or payment integrity operations • Deep expertise in medical claims operations, payment integrity, claims configuration, and regulatory compliance • Proven experience scaling operational organizations in high-growth or complex environments • Strong understanding of healthcare regulations, audit requirements, and industry best practices • Demonstrated ability to lead large, distributed teams and manage complex vendor relationships • Strategic thinker with strong analytical, financial, and operational acumen

🏖️ Benefícios

• Health insurance • 401k program • Flexible PTO • Up to 16 weeks paid parental leave • Paid holidays • Cell phone reimbursement • Transportation perks • Education reimbursement • 1 week of paid paw-ternity leave