VP, Payment Integrity

Limelight Health

Minneapolis (MN)

On-site

USD 180,000 - 280,000

Full time

11 days ago

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Benefits offered by this job

Standard health benefits

Alternative medicine coverage

Flexible PTO

Parental leave (up to 16 weeks)

Paid holidays

401k program

Transportation perks

Education reimbursement

2 days paid paw-ternity leave

Job summary

Gravie is seeking a VP of Payment Integrity to lead strategy, performance, and cross-functional collaboration across Claims, Network, Product, Technology, Finance, and Compliance to improve claims payment accuracy and compliance.

You will build a high-performing, multi-vendor operation, establish savings KPIs, insource opportunities when appropriate, scale operations to support growth and regulatory requirements, and partner with Finance and Med Econ for savings tracking.

Qualifications

15+ years of leadership in healthcare claims or payment integrity.
Executive-level responsibility in healthcare operations.
Experience scaling operational organizations in high-growth or complex environments.
Strong understanding of healthcare regulations and audit requirements.

Responsibilities

Lead payment integrity strategy and execution, including pre- and post-payment reviews and FWA prevention.
Design and lead solutions to reduce leakage across the claims lifecycle.
Assess current program ecosystem and prioritize opportunities for savings.
Manage a multi-vendor portfolio with SLAs and optimized contingency fees.
Provide executive leadership over payment integrity programs.
Lead insourcing initiatives where appropriate.
Establish and monitor savings and KPIs for PI.
Scale operations to support growth and regulatory needs.
Partner with Finance and Med Econ on savings tracking.

Skills

Leadership

Healthcare claims operations

Payment integrity

Regulatory compliance

Vendor management

Strategic thinking

Analytical

Financial acumen

Operational acumen

Job description

Hi, we’re Gravie. Our mission is to create health benefits that actually benefit small and midsize businesses and their employees. Our innovative benefit solutions and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.

A Little More About The Role:

The VP of Payment Integrity is responsible for the leadership, strategy, and performance of Gravie’s payment integrity function, ensuring claims are paid accurately and in compliance with all applicable policies. This role will be responsible for driving the strategy for our pre- and post-pay payment integrity programs, including vendor and internal solutions, and building and leading a high performing team to execute on our strategy. This leader will partner closely with Claims, Network, Product, Technology, Finance, Clinical, Legal/Compliance, and external partners to continuously improve claims payment outcomes, drive plan affordability, and enable Gravie’s growth strategy.

You Will:

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

You Bring:

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

A Little More About Us:

We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.
We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.
Our clients love us. Customer satisfaction rates among employees using Gravie health plans consistently rank above 80% – nearly 40 points above the industry average.
Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at Gravie care deeply about making a positive impact in the lives of the people we serve.

Benefits

Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart.