VP, Payment Integrity

Gravie; United States; Remote; USD 250,000 - 360,000; Full time

Benefits offered by this job

Flexible PTO

Parental leave 16 weeks

Paid holidays

401k program

Transportation perks

Education reimbursement

Paw-ternity leave

Job summary

Gravie is seeking a VP of Payment Integrity to lead strategy and performance of the payment integrity function, ensuring accurate payments and policy compliance. You will drive pre- and post-pay programs, vendor partnerships, and a high-performing team to optimize savings and outcomes for Gravie's growth.

The role requires extensive executive leadership experience in healthcare claims, strong regulatory knowledge, and the ability to scale operations across a multi-vendor ecosystem.

Qualifications

• 15+ years of leadership in healthcare claims or payment integrity
• Deep expertise in claims operations, payment integrity, and regulatory compliance
• Experience scaling large organizations and managing vendor relationships
• Strong analytical, financial and operational acumen
• Ability to lead cross-functional teams and drive cost savings

Responsibilities

• Provide executive leadership over payment integrity operations
• Lead strategy for pre- and post-pay PI programs including FWA prevention
• Build and lead multi-vendor portfolios with strong SLAs
• Develop and monitor savings and KPIs for PI initiatives
• Insource PI opportunities where appropriate
• Partner with Finance and Medical Economics for savings tracking
• Mentor and grow a high-performing leadership team
• Support Gravie’s growth through scalable PI operations

Skills

Leadership

Healthcare claims

Payment integrity

Regulatory compliance

Vendor management

Strategic thinking

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. In addition to standard health and wellness benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and 2 days of paid paw-ternity leave.