Vice President, CCR & Data Mining Intelligence and Process Improvement

Summary

Supported by the VP of Cost Containment Analytics, the Vice President, CCR & Data Mining Intelligence and Process Improvement lead the strategy, operating model, analytics enablement, and process improvement agenda for Payment Integrity claim review, data mining, pre-pay, post-payment, and provider education operations. This executive will be responsible for building scalable capabilities that improve claim audit throughput, accuracy, revenue predictability, and speed-to-value across the Payment Integrity business.

The VP will establish repeatable processes for medical claim review concept ideation, develop new audit and review types, advance data mining intelligence, govern centralized rules engine capabilities, and build reporting frameworks that enable leadership to forecast and manage revenue performance. This role will partner closely with audit operations, data engineering, implementation, delivery, product, technology, finance, and client-facing teams to help deliver sustainable double-digit year-over-year growth.

Your role in our mission

• Lead the development of a scalable claim review intelligence and data mining strategy across Payment Integrity services, including claim audit, pre-pay, post-payment, and provider education.
• Establish repeatable routines for medical claim review concept ideation, prioritization, testing, deployment, monitoring, and refinement.
• Create and launch new audit and review types that enable organic growth, improve client value, and support new sales opportunities.
• Build intelligent processes to balance audit inventory against operational capacity, improving throughput, accuracy, cycle time, and revenue realization.
• Design and sponsor tools, workflows, and applications that increase the velocity and volume of claim reviews performed by audit operations.
• Establish Provider Education as both a standalone offering and an integrated feature of Payment Integrity delivery.
• Partner with analytics, data engineering, technology, and audit operations teams to deliver and govern a centralized rules engine supporting pre-pay and post-payment workflows.
• Build Weekly Leading Indicator and Monthly Leading Indicator reporting frameworks that improve revenue predictability, operational visibility, and executive decision-making.
• Ensure data engineering and data management processes support scalable growth in reporting, concept development, claim selection, analytics deployment, and delivery.
• Partner with implementation and delivery teams to ensure client onboarding and analytics deployment are defect-free, scalable, and aligned to expected revenue outcomes.
• Lead cross-functional initiatives that improve claim selection precision, audit yield, auditor productivity, operational quality, and client performance.
• Serve as an executive partner to Payment Integrity leadership, translating business growth objectives into actionable analytics, process, reporting, and operational strategies.

What we're looking for

• Deep expertise in Payment Integrity operations, including claim audit, data mining, pre-pay, post-payment, and provider education, with the ability to lead strategy and operational execution across these functions.
• Demonstrated success building and scaling analytics-driven operating models, including claim review intelligence, concept ideation, prioritization, testing, deployment, and continuous improvement.
• Strong leadership experience partnering across analytics, data engineering, technology, audit operations, implementation, delivery, finance, and client-facing teams to drive business growth and operational performance.
• Proven ability to design and implement reporting frameworks, workflows, and tools that improve audit throughput, accuracy, revenue predictability, operational visibility, and executive decision-making.
• Track record of translating business objectives into scalable process and analytics strategies, including launching new audit/review types, governing rules-based capabilities, and improving claim selection precision, productivity, and speed-to-value.

What you should expect in this role

• Fully remote position. 
• Opportunity to travel through your work up to 20% of the time.
   

This posting is intended for pipelining. We will accept applications on an ongoing basis.