Vice President Payment Integrity

Cambia Health Solutions • Medford, OR

1d • $217,600 - $294,400 • Hybrid

About The Position

Vice President of Payment Integrity Oregon, Washington, Idaho or Utah (Hybrid) Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia’s dedicated team is living our mission to make health care easier and lives better. As a member of the Customer Experience and Operations team, our VP of Payment Integrity provides executive leadership and strategic oversight of the Payment Integrity organization within Cost Stewardship. This position drives enterprise-wide strategic vision and execution across post-pay and pre-pay audit functions, provider-facing operations and advance analytics capabilities – all in service of creating an economically sustainable health care system. As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us. What You Bring to Cambia: Qualifications: Bachelor's degree, MBA or relevant Master’s degree strongly preferred 5-7 years of experience of direct Payment Integrity leadership experience in a healthcare payer environment with responsibility for audit programs, payment validation, and recovery operations Minimum of 8-10 years of experience in business process design, improvement, and transformation within healthcare payment environments and a minimum of 12-15 years of progressive leadership experience in Healthcare Payment Integrity, Health Plan Claims, Health Plan Operations or related Healthcare management or an equivalent combination of education and experience. Industry certifications such as CPC, CPMA, CFE, or equivalent strongly preferred Skills and Attributes: Technical Expertise Medical & Claims: Comprehensive knowledge of medical coding (CPT, ICD-10, HCPCS), billing practices, reimbursement methodologies, and claims adjudication across professional, institutional, and pharmacy claims Analytics & Technology: Proficiency with SQL, claims processing systems, predictive modeling, and statistical analysis; demonstrated success implementing AI/ML solutions in payment integrity environments Specialized Knowledge: Experience with fraud/waste/abuse detection, COB and subrogation, CMS program integrity requirements, and regulatory compliance Leadership Capabilities Exceptional executive presence with ability to set enterprise-wide strategic vision and influence across matrixed organizations Outstanding communication skills across all organizational levels, including Board and C-suite presentations Proven ability to identify systemic payment inefficiencies, architect comprehensive solutions, and drive consensus among diverse stakeholders Track record building and developing high-performing leadership teams with specialized expertise What You Will Do at Cambia: Enterprise Strategy & Cost Stewardship Establish Payment Integrity strategy as key member of Cost Stewardship leadership team, partnering with Performance and Affordability teams to optimize healthcare value Present strategic initiatives and operational results to Board and C-suite stakeholders Comprehensive Audit Operations Direct pre-pay and post-pay audit programs, recovery operations, and provider-facing activities across all claim types Manage large-scale service provider relationships and optimize audit performance delivery Technology & Analytics Deploy AI/ML solutions and advanced analytics for payment accuracy and competitive advantage Design enterprise measurement frameworks with KPIs tracking audit effectiveness and recovery performance Organizational Leadership Build high-performing teams through strategic talent acquisition, succession planning, and performance management Lead large-scale organizational change initiatives across matrixed healthcare payer environment The expected hiring range for the VP of Payment Integrity is $217,600-294,400 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 30%. The current full salary range for this role is $204,000-333,000. FTEs Supervised 100-200 Work Environment No unusual working conditions. Work is primarily performed in an office environment. About Cambia Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through. Why Join the Cambia Team? At Cambia, you can: Work alongside diverse teams building cutting-edge solutions to transform health care. Earn a competitive salary and enjoy generous benefits while doing work that changes lives. Grow your career with a company committed to helping you succeed. Give back to your community by participating in Cambia-supported outreach programs. Connect with colleagues who share similar interests and backgrounds through our employee resource groups. We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. Annual employer contribution to a health savings account. Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). Award-winning wellness programs that reward you for participation. Employee Assistance Fund for those in need. Commute and parking benefits. Learn more about our benefits. We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb. We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required. If you need accommodation for any part of the application process because of a medical condition or disability, please email [e-mail]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. Everyone is a health care consumer deserving of a simpler, more personalized experience. Cambia is transforming the health care system to revolve around people. For over 100 years we’ve designed people-first health solutions rooted in the nation’s first health plan, a loggers’ wage pool established in the Pacific Northwest. Today that pioneering spirit aligns our family of over 20 companies, including 4 not-for-profit BlueCross and BlueShield licensed health plans serving over 3 million Americans. Cambia blends data science with a compassionate human perspective to anticipate people’s needs, and empower them to make smarter health care choices. Interested in driving accessibility, affordability and quality health care for real people? Apply to any of our open jobs or join the Twitter conversation @Cambia. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

Requirements

• Bachelor's degree, MBA or relevant Master’s degree strongly preferred
• 5-7 years of experience of direct Payment Integrity leadership experience in a healthcare payer environment with responsibility for audit programs, payment validation, and recovery operations
• Minimum of 8-10 years of experience in business process design, improvement, and transformation within healthcare payment environments and a minimum of 12-15 years of progressive leadership experience in Healthcare Payment Integrity, Health Plan Claims, Health Plan Operations or related Healthcare management or an equivalent combination of education and experience
• Comprehensive knowledge of medical coding (CPT, ICD-10, HCPCS), billing practices, reimbursement methodologies, and claims adjudication across professional, institutional, and pharmacy claims
• Proficiency with SQL, claims processing systems, predictive modeling, and statistical analysis; demonstrated success implementing AI/ML solutions in payment integrity environments
• Experience with fraud/waste/abuse detection, COB and subrogation, CMS program integrity requirements, and regulatory compliance
• Exceptional executive presence with ability to set enterprise-wide strategic vision and influence across matrixed organizations
• Outstanding communication skills across all organizational levels, including Board and C-suite presentations
• Proven ability to identify systemic payment inefficiencies, architect comprehensive solutions, and drive consensus among diverse stakeholders
• Track record building and developing high-performing leadership teams with specialized expertise

Nice To Haves

• Industry certifications such as CPC, CPMA, CFE, or equivalent strongly preferred

Responsibilities

• Establish Payment Integrity strategy as key member of Cost Stewardship leadership team, partnering with Performance and Affordability teams to optimize healthcare value
• Present strategic initiatives and operational results to Board and C-suite stakeholders
• Direct pre-pay and post-pay audit programs, recovery operations, and provider-facing activities across all claim types
• Manage large-scale service provider relationships and optimize audit performance delivery
• Deploy AI/ML solutions and advanced analytics for payment accuracy and competitive advantage
• Design enterprise measurement frameworks with KPIs tracking audit effectiveness and recovery performance
• Build high-performing teams through strategic talent acquisition, succession planning, and performance management
• Lead large-scale organizational change initiatives across matrixed healthcare payer environment

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive