VP, Payment Integrity Solutions

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

About Alaffia & Our Mission

Every year, U.S. health plans lose billions to improper payments and administrative waste. That wasted spending ultimately trickles down across the healthcare ecosystem, driving up costs for plans, providers, and patients alike. We’re here to change that paradigm.

Alaffia is a new kind of claims operations partner for health plans. Using expert clinicians and transparent AI, we deliver deeper insights, smarter automation, and consistently better outcomes across the entire lifecycle of claims. With Alaffia, health plans can cut wasted spending more effectively than ever — and provide their members the most affordable care.

We’re a high-growth, venture-backed Series B healthtech startup based in NYC and are actively scaling our company. Join us in helping to build a healthcare system that works better for everyone.

Role Overview

We are seeking a seasoned clinical Payment Integrity (PI) executive to join Alaffia as Vice President of Clinical Claims Solutions. In this role, you will own the strategy, growth, and delivery of Alaffia's clinical PI offerings across our health plan client base. You will lead a team of implementation and client-facing specialists, serve as a senior executive sponsor for our most strategic accounts, and partner closely with Product, Engineering, and Sales leadership to shape the direction of our AI-powered platform. This is a defining leadership role for a high-growth company tackling $570B+ in industry waste.

Key Responsibilities

• Executive Leadership & Strategy: Define and execute the go-to-market and delivery strategy for Alaffia's clinical claims solutions. Set the vision for how our agentic AI platform serves health plan clients across pre-pay, post-pay, itemized bill review, DRG validation, hospital bill audit, and complex claim review, upcoding detection, and overpayment recovery. Own the roadmap for scaling our PI offerings and translating it into measurable client and business outcomes.
• Client Executive Sponsorship: Serve as the senior executive point of contact for Alaffia's most strategic health plan clients. Build and sustain C-suite and VP-level relationships, lead executive business reviews, and ensure clients realize ongoing and expanding value from Alaffia's solutions. Navigate complex escalations and serve as a trusted long-term partner.
• Team Building & Development: Recruit, lead, and mentor a high-performing team of Directors and implementation/client success specialists. Foster a culture of clinical excellence, accountability, and client obsession. Define team structure, role clarity, and career development pathways as the organization scales.
• Revenue Growth & Expansion: Partner with Sales and Solutions leadership to drive new logo acquisition and expand existing accounts. Bring credibility and executive presence to late-stage sales pursuits, strategic demos, and contract negotiations. Identify and champion opportunities to deepen AI/agentic tool adoption within client environments.
• Cross-Functional Partnership: Act as the senior voice of the client and clinical PI practitioner across internal stakeholder groups — Product, Engineering, Operations, and Clinical. Influence the product roadmap based on real-world client feedback and emerging industry trends. Ensure tight alignment between delivery and commercial commitments.
• Operational Excellence: Establish scalable processes for implementation, onboarding, and ongoing client support. Define and track KPIs for clinical accuracy, client satisfaction, savings delivery, and team performance. Drive continuous improvement across all client-facing workflows.
• Industry Thought Leadership: Represent Alaffia externally at industry forums, conferences, and client advisory sessions. Stay ahead of regulatory developments (CMS guidelines, state/federal compliance), evolving PI challenges (complex claim review, DRG validation, itemized bill review), and AI innovation in healthcare claims.

Qualifications

• 12+ years in healthcare payment integrity, with a significant portion in senior leadership. Deep hands-on expertise in complex facility claim review — including itemized bill review (IBR), DRG validation, and hospital bill audit — plus medical necessity review, coding validation (DRG, CPT), and improper payment identification.
• Demonstrated success leading and scaling client-facing or operational teams in a health plan, PI vendor, or related environment.
• Proven executive presence — comfortable presenting to C-suite audiences, leading strategic negotiations, and representing a company externally.
• Track record of driving material savings outcomes, building high-performing teams, and scaling PI programs.
• Strong clinical background (RN, clinical reviewer, or equivalent) combined with the ability to speak credibly about AI-enabled tools, claims platforms, and automation.
• Excellent communication and executive storytelling skills; able to translate complex clinical and technical concepts for diverse audiences.

Nice to haves

• Experience with AI or agentic AI tools in healthcare claims; prior leadership at a company leveraging transparent clinical AI.
• Background spanning health plan operations, utilization management, appeals, or Special Investigations Unit (SIU).
• Knowledge of regulatory environments and common PI challenges including upcoding and DRG-related billing discrepancies.
• Bachelor's or advanced degree in nursing, healthcare administration, or a related field. Relevant certifications (CCS, RHIA, CPC) are a plus.

What Else Do You Get Working With Us?

• Competitive Compensation
• Medical, Dental, and Vision benefits
• Flexible, paid vacation policy
• Work in a flat organizational structure — direct access to Leadership