Vice President of Payment Integrity AI Solutions

Vice President of Payment Integrity AI Solutions

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary The Vice President, AI Solutions for Payment Integrity will lead business-level product strategy, roadmap execution, and market enablement for AI-powered solutions across the Payment Integrity portfolio. This executive will own end-to-end product management delivery for new and existing AI capabilities, including AI Assistant, AI Reviewer, Policy Healthcheck, AI foundational agents, and domain-specific agents. This role will partner closely with Cost Containment Operations, Analytics, Product, Technology, Transformation, Sales, Implementation, and Delivery teams to develop AI solutions that create measurable revenue growth, operational efficiency, improved claim review quality, and stronger client value. The VP will be responsible for converting business hypotheses into prototypes, validating solutions with the market, enabling adoption through change management, and directly supporting sales efforts to improve win rates and accelerate pipeline growth.

Your role in our mission Own end-to-end business-level product management for Payment Integrity AI solutions, including roadmap planning, prioritization, feature definition, delivery coordination, adoption, and performance measurement. Lead the strategy and execution for AI-powered capabilities, including AI Assistant, AI Reviewer, Policy Healthcheck, AI foundational agents, and domain-specific Payment Integrity agents. Partner with Technology, Product, Analytics, Operations, and Delivery teams to translate business needs into scalable AI capabilities that improve audit performance, operational efficiency, and client outcomes. Work with Cost Containment Operations leaders to develop new hypotheses that drive material revenue growth, reduce operating costs, increase audit throughput, improve accuracy, and enable double-digit year-over-year growth. Develop prototypes, pilots, and minimum viable products to validate market demand, internal usability, functional design, and feature effectiveness. Partner with the Transformation team to ensure change management processes are executed effectively and that new AI capabilities are operationalized across relevant teams. Ensure go-to-market readiness for new AI solutions, including sales enablement, value proposition development, training, implementation readiness, delivery models, and adoption plans. Directly support sales efforts for Cost Containment and Payment Integrity solutions by articulating AI solution value, participating in client and prospect discussions, and helping improve win rates and pipeline velocity. Define success metrics for AI solutions, including revenue impact, adoption, operational efficiency, user productivity, audit quality, client value, and return on investment. Monitor solution performance and partner with stakeholders to refine AI capabilities based on market feedback, operational outcomes, and business priorities. Serve as an executive thought partner on the responsible, practical, and scalable use of AI across Payment Integrity operations and client-facing solutions.

What we're looking for Master's degree in Computer Science, Data Science, AI, or a related field. 15+ years of experience in AI/ML, with at least 7 years in leadership roles focused on implementing and scaling AI solutions. Demonstrated success in delivering AI products in healthcare or other regulated industries. Expertise in integrating AI technologies, including GenAI, into complex systems and ensuring their operational viability. Strong project management skills with the ability to manage budgets, timelines, and resources effectively. Excellent communication and stakeholder management skills to align AI initiatives with business priorities.

What you should expect in this role Fully Remote Opportunity with the option to work anywhere within the United States. Opportunities to travel through your work (0-10%). This posting is intended for pipelining. We will accept applications on an ongoing basis. The pay range for this position is $192,000.00 - $275,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.