Vice President of Clinical Claims Solutions

Job Summary

To drive the strategy and growth of clinical payment integrity offerings, the full-time remote Vice President of Clinical Claims Solutions will lead a team, serve as the executive sponsor for strategic health plan clients, and collaborate with cross-functional leaders to enhance AI-powered solutions.

Key Responsibilities

• Define and execute the go-to-market strategy for clinical claims solutions, focusing on scaling offerings and achieving measurable outcomes
• Build and sustain relationships with C-suite clients, ensuring they receive ongoing value and navigating complex escalations
• Recruit and mentor a high-performing team, fostering a culture of clinical excellence and accountability

Required Qualifications

• 12+ years of experience in healthcare payment integrity, with significant senior leadership experience
• Expertise in complex facility claim review, including itemized bill review and DRG validation
• Proven executive presence and success in leading client-facing teams in a health plan or PI vendor environment
• Strong clinical background (RN or equivalent) with knowledge of AI-enabled tools in healthcare claims
• Excellent communication skills with the ability to present complex concepts to diverse audiences