Job Description
To provide strategic direction and centralized leadership to the provider payment integrity and reimbursement policy functions inclusive of prepayment clinical and coding requirements and post payment recoupment, to promote accuracy in claims payment and correct coding to drive savings. Leads strategies for reimbursement policy development, claims editing, post payment analytics and recoupment efforts, provider education, coordination of benefits and development of new innovative programs to drive downstream cost savings for the organization. Has direct or matrixed accountability for SIU integration with or other payment integrity activities. Ensures alignment and compliance with industry standards and accountable for cost of care initiatives and assigned targets to provide affordable care to members.Blue Cross NC is seeking a strategic and innovative Vice President, Payment Integrity to lead the vision, strategy, and execution of enterprise payment integrity programs that advance affordability, payment accuracy, and operational excellence.
As a key member of the leadership team, this executive will oversee initiatives designed to prevent, identify, and recover inaccurate healthcare payments while enhancing provider experience and supporting sustainable healthcare costs. The Vice President will partner across Finance, Medical Economics, Provider Network Management, Clinical Operations, Technology, Compliance, and Legal to drive measurable impact through analytics, automation, and process innovation.
What You'll Do
- Assess the Payment Integrity ecosystem, prioritize high-value opportunities, and establish KPIs for savings, operations, and performance tracking.
- Develop and execute an enterprise-wide Payment Integrity strategy aligned with organizational affordability and performance goals.
- Lead programs focused on payment accuracy, claims integrity, coding validation, recovery operations, coordination of benefits, and related payment integrity functions.
- Leverage advanced analytics, automation, and emerging technologies to identify opportunities, reduce waste, and improve outcomes.
- Establish performance metrics, governance frameworks, and reporting to measure business impact and value realization.
- Partner with provider-facing teams to balance payment accuracy with a positive provider experience.
- Manage a high-performing multi-vendor portfolio by enforcing SLAs, optimizing fee structures, and minimizing provider abrasion.
- Serve as a trusted advisor to executive leadership on payment integrity trends, risks, opportunities, and industry best practices.
- Build and develop a high-performing team while fostering a culture of innovation, accountability, and continuous improvement.
What You'll Bring
- Bachelor's degree in Business, Healthcare Administration, Finance, Public Health, or a related field.
- 12+ years of progressive leadership experience in payment integrity, healthcare economics, claims operations, health plan operations, revenue cycle, or a related healthcare function.
- Proven success leading large-scale strategic initiatives and high-performing teams within a payer, health plan, consulting organization, or healthcare enterprise.
- Deep knowledge of healthcare reimbursement methodologies, claims administration, payment accuracy, and regulatory requirements.
- Strong financial, analytical, and business acumen with the ability to translate complex data into actionable strategies.
- Exceptional executive presence, communication skills, and ability to influence across diverse stakeholder groups.
Why Blue Cross NC
At Blue Cross NC, we're committed to making healthcare better and more affordable for the people we serve. This role offers a unique opportunity to shape the future of payment integrity, influence enterprise strategy, and drive meaningful impact on affordability, operational performance, and healthcare outcomes across North Carolina and beyond.
Join us and help transform healthcare through innovation, integrity, and strategic leadership.
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JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected].
Skills Required
- Bachelor's degree in Business, Healthcare Administration, Finance, Public Health, or related field
- 12+ years progressive leadership experience in payment integrity, healthcare economics, claims operations, health plan operations, or related healthcare function
- Proven success leading large-scale strategic initiatives and high-performing teams within a payer, health plan, consulting organization, or healthcare enterprise
- Deep knowledge of healthcare reimbursement methodologies, claims administration, payment accuracy, and regulatory requirements
- Strong financial, analytical, and business acumen with ability to translate complex data into actionable strategies
- Exceptional executive presence, communication skills, and ability to influence diverse stakeholder groups
- Experience leveraging advanced analytics, automation, and emerging technologies to drive payment integrity
- Experience managing multi-vendor portfolios, enforcing SLAs, and minimizing provider abrasion
What We Do
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina. Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Our company is a not-for-profit with headquarters in Durham and major operations in Winston-Salem and Fayetteville. In all we employ more than 4,500 North Carolinians and serve more than 3.7 million customers. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association.
