Vice President of Clinical Claims

Job Summary

To lead the strategy and growth of clinical payment integrity solutions, the full-time remote Vice President of Clinical Claims will manage client relationships, oversee a high-performing team, and collaborate with cross-functional leaders to enhance AI-driven offerings in the healthcare sector.

Key Responsibilities

• Define and execute the go-to-market strategy for clinical claims solutions, ensuring alignment with client needs and business outcomes
• Serve as the senior executive point of contact for strategic health plan clients, fostering relationships and ensuring client satisfaction
• Recruit and mentor a team of specialists, promoting a culture of clinical excellence and accountability

Required Qualifications

• 12+ years of experience in healthcare payment integrity with significant senior leadership exposure
• Proven success in leading client-facing or operational teams within health plans or related environments
• Strong clinical background (RN, clinical reviewer, or equivalent) with expertise in coding validation and improper payment identification
• Demonstrated executive presence and ability to engage with C-suite audiences and lead strategic negotiations
• Track record of driving savings outcomes and scaling payment integrity programs