VP, Clinical Claims Solutions – AI-Driven PI Leader

Alaffia Health; United States; Hybrid; USD 250,000 - 600,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

Flexible vacation policy

Direct access to Leadership

Job summary

Alaffia Health is seeking a seasoned executive to lead Clinical Claims Solutions, owning strategy, growth, and delivery for our PI offerings across health plan clients. You will direct implementation and client-facing teams, serve as a senior sponsor for strategic accounts, and collaborate with Product, Engineering, and Sales to shape our AI-powered platform.

This leadership role targets expanding value through pre- and post-pay claim reviews, DRG validation, and complex claim review, ensuring

Qualifications

• 12+ years in healthcare payment integrity or PI leadership roles.
• Experience leading client-facing or operational teams in health plans or PI vendors.
• Proven executive presence with experience in C-suite engagements and strategic negotiations.
• Track record of delivering material savings and scaling PI programs.

Responsibilities

• Define and execute go-to-market and delivery strategy for Alaffia's PI offerings.
• Lead a team of Directors and implementation/client success specialists.
• Manage executive sponsorship for strategic health plan clients and client reviews.
• Drive new logo acquisition and expansion within existing accounts.
• Align product roadmap with client feedback and industry trends.
• Establish scalable processes for implementation, onboarding, and support.

Skills

Executive leadership

Strategic go-to-market

Client sponsorship

AI-enabled tools

Healthcare PI domain

Education

Nursing / healthcare administration degree

Tools

AI-enabled PI platforms

Claims processing systems

Job description

Alaffia Health is seeking a seasoned executive to lead Clinical Claims Solutions, owning strategy, growth, and delivery for our PI offerings across health plan clients. You will direct implementation and client-facing teams, serve as a senior sponsor for strategic accounts, and collaborate with Product, Engineering, and Sales to shape our AI-powered platform.

This leadership role targets expanding value through pre- and post-pay claim reviews, DRG validation, and complex claim review, ensuring