Vice President Integrity

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.

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.

• 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

• 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

• 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

• 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

The expected hiring range for the VP of Payment Integrity is $,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 $,000.

100-200

• No unusual working conditions.
• Work is primarily performed in an office environment.

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.

In this role 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…