VP, Payment Integrity

🔥 1 hour ago

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Gravie

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2013

🏥 Healthcare

🛡️ Insurance

🤝 B2B

💰 $150M Private Equity Round - Gravie on 2025-05

Healthcare • Insurance • B2B

Gravie is a benefits and health insurance solutions company that helps small and midsize employers, brokers, and employees access and administer more flexible, affordable health benefits. Its flagship offerings include Comfort (a level-funded health plan), Gravie ICHRA (Individual Coverage Health Reimbursement Arrangement administration), Gravie Pay (support for healthcare costs), and Gravie Care; the company focuses on enabling SMBs to offer individualized, lower-cost coverage and simplifying benefits administration.

📋 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, 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

🏖️ 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