VP, Payment Integrity Solutions

Responsibilities

• Define and execute the go-to-market and delivery strategy for clinical claims solutions, including pre-pay, post-pay, and overpayment recovery.
• Serve as the senior executive sponsor for strategic health plan clients, building C-suite and VP-level relationships.
• Recruit, lead, and mentor a high-performing team of Directors and implementation specialists.
• Partner with Sales and Product leadership to drive new logo acquisition and influence the AI-powered platform roadmap.
• Establish scalable processes for implementation, onboarding, and ongoing client support.
• Represent Alaffia at industry forums and conferences as a thought leader in payment integrity and AI innovation.

Requirements

• 12+ years of healthcare payment integrity experience, with significant senior leadership tenure.
• Deep expertise in clinical claim review, medical necessity, and coding validation (DRG, CPT).
• Strong clinical background (RN or equivalent).
• Proven executive presence with experience presenting to C-suite audiences and leading strategic negotiations.
• Demonstrated success in scaling client-facing or operational teams within a health plan or PI vendor environment.

Preferred Qualifications

• Experience with AI or agentic AI tools in healthcare claims processing.
• Background in health plan operations, utilization management, appeals, or Special Investigations Unit (SIU).
• Advanced degree in nursing, healthcare administration, or a related field.
• Relevant industry certifications such as CCS, RHIA, or CPC.

Benefits

• Competitive compensation package.
• Medical, dental, and vision benefits.
• Flexible, paid vacation policy.
• Opportunity to work in a flat organizational structure with direct access to leadership.

About the Company

Alaffia is a high-growth, venture-backed Series B healthtech startup. We are a new kind of claims operations partner for health plans, using expert clinicians and transparent AI to deliver deeper insights and smarter automation. Our mission is to reduce improper payments and administrative waste to help provide members with more affordable care.