Director, Payment Integrity Solutions

About Alaffia & Our Mission

Every year, U.S. health plans lose billions to improper payments and administrative waste. That wasted spending ultimately trickles down across the healthcare ecosystem, driving up costs for plans, providers, and patients alike. We're here to change that paradigm.

Alaffia is a new kind of claims operations partner for health plans. Using expert clinicians and transparent AI, we deliver deeper insights, smarter automation, and consistently better outcomes across the entire lifecycle of claims. With Alaffia, health plans can cut wasted spending more effectively than ever — and provide their members the most affordable care.

We're a high-growth, venture-backed Series B healthtech startup based in NYC and are actively scaling our company. Join us in helping to build a healthcare system that works better for everyone.

About the Role & What You'll Be Doing

We're looking for a Payment Integrity (PI) leader who can take health plan clients from signed contract to successful go-live, and who knows PI well enough to design the solution and then deliver it. As Director, PI Solutions (Implementations), you will own client implementations end to end, shape how our AI platform and managed services are configured around real PI workflows, and build the repeatable playbook that lets us scale.

Client implementation demand is growing fast, and this role is central to our ability to deliver. You'll work closely with Operations, Product, Engineering, and Client Services, and act as a trusted advisor to client stakeholders throughout onboarding.

Your Responsibilities

• Lead client implementations from kickoff through go-live and stabilization, including scoping, requirements gathering, workflow configuration, testing, and launch

• Translate client PI programs (pre-pay, post-pay, clinical editing, DRG validation, overpayment recovery) into effective configurations of Alaffia's platform

• Build and refine our implementation playbook, templates, and best practices, especially for health plan environments

• Serve as the senior client contact during onboarding, including executive updates, risk management, and expectation setting

• Partner with Operations, Product, Engineering, and Clinical teams to resolve blockers and turn client feedback into product and process improvements

• Hand off cleanly to Account Management and Client Services, and identify opportunities to expand use of Alaffia's AI tools within client environments

• Join late-stage sales conversations to scope implementation approach, timelines, and feasibility

• Mentor and develop implementation and solutions team members

What We're Looking For

• 8+ years in healthcare payment integrity at a health plan or PI vendor, with strong knowledge of claims review, coding validation (DRG, CPT), and how improper payments are identified and recovered

• Proven track record leading complex claims, PI, or healthcare technology implementations, from requirements through go-live (health plan implementation experience strongly valued)

• Experience managing executive-level client relationships and communicating clearly through risk, delays, and change

• Strong project and program management skills, including managing multiple concurrent implementations

• Comfort with AI-enabled tools, claims platforms, or automation, and credibility with both PI operators and engineers

• Excellent written and verbal communication

• Demonstrated success driving savings, improving accuracy, or scaling PI programs

Nice to have:

• Experience with agentic AI or transparent clinical AI in healthcare claims

• Background in health plan operations, utilization management, appeals, or SIU

• Experience building an implementation function or playbook at a growth-stage company

• Familiarity with CMS and state/federal compliance, and common PI issues like upcoding, unbundling, and coordination of benefits

Our Culture

Alaffia was born out of our founders' personal connection to the inefficiency of the U.S. healthcare system. We are deeply mission-driven, with an abiding belief that technology can help create a better future for everyone — and we're looking for others who share our passion for change to join the team.

What Else Do You Get Working With Us?

• Competitive Compensation

• Medical, Dental, and Vision benefits

• Flexible, paid vacation policy

• Work in a flat organizational structure — direct access to Leadership