Vice President, Payment Integrity

Gainwell Technologies

. Develop high-quality business strategies and operational plans aligned with Gainwell’s short-term and long-term objectives for the solution offering .

Posted 9/25/2026full-timeRemote • Wisconsin • United StatesLead💰 $156,100 - $223,000 per yearWebsite

About the role

Key responsibilities & impact

Develop high-quality business strategies and operational plans aligned with Gainwell’s short-term and long-term objectives for the solution offering
Oversee payment integrity delivery operations to drive revenue growth, margin expansion, and client satisfaction
Lead and motivate team members, develop a high-performing managerial team, and partner cross-functionally with Finance, Account Management, Sales, Engineering, and Implementations
Manage pre-payment and post-payment payment integrity solutions, including Clinical Claim Reviews, Payment Analytics/Data Mining, FraudCapture, Utilization Review, Long-Term Care, and Credit Balance
Develop, manage, and attain revenue and expense budget goals
Manage product portfolio development plans with technical development partners in alignment with client needs and revenue forecasting
Monitor systems and processes that identify and mitigate payment integrity revenue portfolio opportunities and risks
Apply advanced financial analysis and forecasting techniques to project and optimize revenue
Collaborate with the VP Product on product expansion and annual revenue targets
Partner with the AI development team on projects improving efficiency, accelerating growth, and speeding go-to-market solutions
Represent the company in pre-sales solutioning efforts and collaboratively design solutions with Gainwell SGMs and HMS SVP Client Management
Partner with clinical operations on demand, capacity, and compliance with client SLAs and contract requirements
Oversee RFP and new business proposal reviews for strategic fit and implementation, operational, and financial success
Improve product quality through defect identification, root cause analysis, and corrective action project management
Improve internal product processes through Lean and AI-driven continuous quality improvement methodologies
Manage staffing planning and workforce management tools across the delivery team
Build operational metrics covering service efficiency, quality, cost per unit, productivity, staffing to demand, appeals, and analytics efficacy
Coordinate with the product implementation team on solution architecture and end-to-end project management of new implementations
Communicate product strategy, financial results, operational status, and quality/compliance issues to company leadership
Lead delivery teams through regular communication, recognition, and quarterly Town Hall meetings
Direct leadership development and training, including bench strength and succession planning
Participate in talent and succession management review sessions as a Talent Management champion

Requirements

What you’ll need

At least fifteen years of gradually increasing product, finance and/or operational leadership experience
Experience working within the payer side of the healthcare industry required
Experience with Medicaid preferred
At least five years of leadership experience in payment integrity operations required
Familiarity with AI interventions leading to revenue acceleration and cost reduction strongly preferred
Strong interpersonal and influence skills to cultivate relationships, facilitate negotiations, and build partnerships with customers and key stakeholders
Strong strategic management, product management, planning, operational and analytical skills
Proven experience working in complex organizations
Travel based on client, program, and leadership needs, anticipated up to 15% annually

Benefits

Comp & perks

Work flexibility
Learning and career development
Technical credentials and certifications
Generous, flexible vacation policy
Educational assistance
Comprehensive leadership and technical development academies
401(k) employer match
Comprehensive health benefits
Travel expense reimbursement (included among Gainwell’s stated benefits)
Life insurance (included among Gainwell’s stated benefits)