VP, Payment Integrity

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.

• 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

• 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

In order to transform health insurance and build a health plan everyone can love, we need talented people doing amazing work. In exchange, we offer a great overall employee experience with opportunities for career growth, meaningful mission-driven work, and an above average total rewards package.

The salary range for this position is $207,000- $304,000 annually. Numerous factors including, but not limited to, education, skills, work experience, certifications, etc. will be considered when determining compensation. In addition to base salary, this position is also eligible to participate in Gravie’s annual bonus program. Stock options may also be awarded as part of the compensation package.

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, cell phone reimbursement, transportation perks, education reimbursement, and 1 week of paid paw-ternity leave.

• 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. We may not be the right place for everybody, but if you get energized by doing work every day that focuses on putting consumers at the front of the line, we could be a great place for you. It takes unique people and diverse perspectives to deliver our results. We encourage you to be your authentic self – we like you that way.