VP, Payment Integrity

🕒 il y a 10 jours

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Gravie

Site WebLinkedInTous les Emplois

201 - 500 employés

Fondée en 2013

🏥 Santé

🛡️ Assurance

🤝 B2B

💰 €150 000 000 Private Equity Round - Gravie en 2025-05

Healthcare • Insurance • B2B

Gravie est une entreprise spécialisée dans les solutions d'assurance santé et de prestations qui aide les petites et moyennes entreprises, les courtiers et les employés à accéder et à gérer des prestations de santé plus flexibles et abordables. Ses offres phares incluent Comfort (un plan de santé à financement partiel), Gravie ICHRA (gestion des remboursements des frais médicaux pour les couvertures individuelles), Gravie Pay (assistance pour les coûts liés aux soins de santé) et Gravie Care. L'entreprise se concentre sur la capacité des PME à offrir des couvertures individualisées à moindre coût, tout en simplifiant la gestion des prestations.

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

🎯 Exigences

• 15+ years of progressive leadership experience in healthcare claims or payment integrity operations, including significant executive-level responsibility • 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

🏖️ Avantages

• 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