VP, Payment Integrity

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Gravie

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

💳 Fintech

🤝 B2B

Healthcare Insurance • Fintech • B2B

Gravie is a company specializing in providing innovative health benefits and insurance solutions. Their offerings include the Comfort health plan, which simplifies health coverage with no deductibles and zero copays on common healthcare services. Gravie also provides Individual Coverage Health Reimbursement Arrangements (ICHRA) and Gravie Pay, a support system for managing healthcare costs. The company emphasizes clear and straightforward benefits that facilitate preventive care and reduce unexpected healthcare expenses, catering to both individual members and small to midsize businesses. Gravie aims to make health benefits accessible, understandable, and cost-effective for employers and employees alike.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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