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Executive Payer Matrix Jobs (NOW HIRING)

DBV Technologies

... building executive-level payer relationships, and operating in a fast-moving, pre-commercial ... Demonstrated ability to collaborate with a diverse matrix of internal stakeholders (e.g., Market ...

Revolution Medicines

Senior Director, HEOR/RWE - GI

Reporting to the Executive Director of HEOR/RWE GI, the Senior Director, HEOR/RWE will: * Develops ... matrix teams and working groups. * Leads enterprise partnerships with payers, HTA agencies, and ...

Atrium Health

CFO Georgia Market

Piedmont, AL · On-site

$150 - $200/hr

... matrix departments. * Collaborate with operations management and corporate revenue cycle ... Present financial information to governance boards, subcommittees and executive management.

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Executive Payer Matrix information

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$26.5K

$93.6K

$184K

How much do executive payer matrix jobs pay per year?

As of Jul 25, 2026, the average yearly pay for executive payer matrix in the United States is $93,552.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,000.00 and $120,500.00 per year, depending on experience, location, and employer.

How does an Executive Payer Matrix professional typically collaborate with cross-functional teams within healthcare organizations?

Executive Payer Matrix professionals frequently work alongside sales, marketing, medical affairs, and market access teams to develop and implement payer strategies for pharmaceutical products or healthcare services. They facilitate communication between internal stakeholders and external payer organizations, ensuring alignment on reimbursement goals and value propositions. Successful collaboration often involves regular strategy meetings, data sharing, and joint problem-solving to address payer challenges and optimize product access. Building strong interdepartmental relationships is key to navigating complex payer landscapes and driving organizational success.

What is the difference between Executive Payer Matrix vs Payer Relations Manager?

AspectExecutive Payer MatrixPayer Relations Manager
CredentialsRelevant healthcare, insurance, or business certificationsHealthcare or insurance-related certifications often preferred
Work EnvironmentCorporate offices, healthcare organizations, insurance companiesHealthcare providers, insurance companies, healthcare networks
Industry UsageUsed in healthcare administration, insurance strategy, and payer managementCommonly found in healthcare provider organizations managing payer relationships
Search & Comparison IntentUnderstanding strategic payer management rolesLearning about payer relationship management in healthcare

The Executive Payer Matrix focuses on high-level strategic management of payer relationships, often involving policy and contract negotiations. In contrast, the Payer Relations Manager handles day-to-day interactions with payers, ensuring smooth communication and compliance. Both roles are vital in healthcare finance but differ in scope and responsibilities.

What is an Executive Payer Matrix?

An Executive Payer Matrix is a strategic tool used in healthcare organizations to map out and analyze relationships with key payer organizations, such as insurance companies, government payers, and managed care organizations. It helps executives and decision-makers understand payer priorities, contract terms, reimbursement rates, and potential areas for negotiation. This matrix is crucial for optimizing payer relationships, improving reimbursement outcomes, and aligning organizational strategies with payer requirements. By using an Executive Payer Matrix, healthcare organizations can better anticipate changes in the payer landscape and respond proactively to challenges.

What are the key skills and qualifications needed to thrive as an Executive Payer Matrix, and why are they important?

To thrive as an Executive in Payer Matrix management, you need expertise in healthcare reimbursement, payer relations, and strategic business development, often supported by a degree in healthcare administration or a related field. Familiarity with claims processing systems, payer contract management platforms, and compliance regulations is crucial. Exceptional negotiation, leadership, and analytical skills help drive successful partnerships and organizational growth. These abilities ensure effective navigation of complex payer landscapes, maximizing reimbursement and supporting overall business objectives.
More about Executive Payer Matrix jobs
What cities are hiring for Executive Payer Matrix jobs? Cities with the most Executive Payer Matrix job openings:
What are the most commonly searched types of Payer Matrix jobs? The most popular types of Payer Matrix jobs are:
What states have the most Executive Payer Matrix jobs? States with the most job openings for Executive Payer Matrix jobs include:
What job categories do people searching Executive Payer Matrix jobs look for? The top searched job categories for Executive Payer Matrix jobs are:
Executive Payer Matrix jobs near you
Infographic showing various Executive Payer Matrix job openings in the United States as of July 2026, with employment types broken down into 91% Full Time, 5% Part Time, and 4% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $93,552 per year, or $45 per hour.
Senior Assistant Vice President - Healthcare Claims AI - Technical Product Leader

Senior Assistant Vice President - Healthcare Claims AI - Technical Product Leader

EXL

Washington, DC • On-site

Other

Medical, Vision

This job post has expired today. Applications are no longer accepted.

ExlService Holdings rating

7.8

Company rating: 7.8 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

119th of 454 rated business services

Job description

Product Development-Product Development

Healthcare Claims AI / Technical Product Leader to own the vision, strategy, and delivery of AI-powered products and solutions across the healthcare claims lifecycle. This role sits at the intersection of product strategy, AI engineering leadership, and healthcare claims domain expertisespanning claims adjudication, claims adjustment, payment integrity (PI), coordination of benefits (COB), subrogation, provider dispute resolution, and fraud/waste/abuse (FWA) detection.

You will lead cross-functional teams to architect, build, and operationalize Agentic AI and Generative AI solutions that create measurable valuereducing claims processing costs, accelerating adjudication turnaround, improving payment accuracy, strengthening audit outcomes, and modernizing provider operations workflows. This is a high-visibility leadership role ideal for someone passionate about combining technology, healthcare claims depth, and design thinking to create lasting business impact for national payers.

Responsibilities

AI Product Strategy & Roadmap Ownership

  • Define, own, and evolve the AI product roadmap for healthcare claims solutionsspanning claims adjudication automation, claims adjustment, payment integrity, COB/subrogation, provider issue resolution, and FWA detection.
  • Translate complex claims operational challenges into AI-first product strategies with clear business cases, ROI frameworks, and measurable KPIs (e.g., auto-adjudication rate, denial accuracy, overpayment recovery yield).
  • Drive solutions from ideation ? POC ? MVP ? production scale, using agile execution and business-centric prioritization.
  • Maintain a competitive landscape matrix and continuously benchmark against market players (Optum/Change Healthcare, Cotiviti, Cognizant TriZetto, HealthEdge, Conduent, etc.) to inform differentiation strategy.
  • Partner with sales, finance, and leadership to determine pricing, packaging, and go-to-market approach (managed services, SaaS, outcome-based/gainshare models).

Technical & AI Engineering Leadership

  • Drive the transition from traditional rules-engine claims processing to AI-augmented adjudicationautomating claim edits, benefit configuration interpretation, provider contract parsing, and payment rule application.
  • Design reusable AI components and platform capabilities (e.g., claims document intelligence, EOB/remittance parsing, provider contract extraction, coding validation engines, browser/desktop automation agents).
  • Write clear product requirements documents (PRDs), user stories, and technical specifications with well-defined acceptance criteria for engineering teams.
  • Champion explainability-first AI design, ensuring all models produce audit-ready, evidence-grounded outputs suitable for SIU investigations, CMS audits, and payer compliance reviews.

Healthcare Claims Domain & Operational Transformation

  • Apply deep knowledge of end-to-end claims operationsclaim intake, edits, adjudication, pricing, payment, adjustment, appeals, grievances, provider disputes, and overpayment recoveryto identify high-impact AI use cases.
  • Embed AI solutions into core claims platforms and systems (QNXT, Facets, Amisys, HealthRules Payer, CSC/DXC, etc.) through platform-agnostic integration and API-first design.
  • Design AI-driven solutions covering pre-pay and post-pay analytics, DRG validation, code editing (CPT/ICD-10/HCPCS), duplicate claim detection, and provider billing pattern analysis.
  • Build cross-payer intelligence capabilities that leverage anonymized, aggregated claims data to drive payment accuracy benchmarks, denial pattern optimization, and cost-of-care insights.
  • Support RFP/RFI responses, orals preparation, and executive presentations for national payer pursuits.
  • Develop AI-powered provider operations solutionsautomated provider issue resolution, correspondence generation, contract interpretation, and fee schedule management.

Client Engagement & Thought Leadership

  • Serve as the product spokesperson and AI SME in client engagementsleading executive presentations, POC demonstrations, workshops, and roadmap discussions with CXO/EVP/VP stakeholders at national payers.
  • Partner with account management and business development teams to shape differentiated claims AI solutions for complex, enterprise-level healthcare pursuits.
  • Build and deliver compelling thought leadership contentwhite papers, case studies, conference presentations, and analyst briefingsthat position EXL as a leader in claims AI innovation.
  • Represent EXL at industry conferences (AHIP, HCCA, SIU conferences, RISE, etc.) through presentations, panel discussions, and live product demonstrations.

Team Leadership & Talent Development

  • Lead, mentor, and develop a high-performing team of AI engineers, product managers, data scientists, and solution architects focused on claims AI.
  • Foster a culture of innovation, collaboration, accountability, and continuous learning within the team.
  • Collaborate with offshore engineering and delivery teams to ensure timely, secure, and scalable implementation.
  • Build and scale an AI Center of Excellence for healthcare claims, establishing reusable agent frameworks, governance playbooks, and best practices.

Governance, Compliance & Risk Management

  • Champion privacy-first design, data anonymization, and compliance with HIPAA, PHI/PII handling, and payer-specific data governance frameworks.
  • Ensure all AI solutions meet scalability, security, auditability, and operational excellence requirements for regulated healthcare claims environments.
  • Establish governance-grade AI controls including model monitoring, bias detection, drift management, and human-in-the-loop override mechanisms for claims decisioning.
  • Maintain compliance with CMS, state DOI regulations, NAIC guidelines, and payer-specific audit requirements for claims processing and payment integrity.
Qualifications

Experience

  • 15+ years of progressive experience in AI/ML engineering, technical product management, or platform product leadership roles.
  • 5+ years of leadership experience in healthcare claims technology, payer claims operations, or health-tech product organizations focused on claims/PI.
  • Proven track record of building and scaling AI solutions for claims processing, payment integrity, or provider operationsfrom POC to production at an enterprise scale.
  • Experience with large-scale payer claims engagements ($25M+ in managed services or technology contracts) and familiarity with FTE-to-AI transformation models in claims shops.
  • Bachelor's degree in computer science, Engineering, Data Science, or related technical field. Master's degree (M.Tech / MS / MBA) is strongly preferred.

Technical Skills

  • Hands-on and architectural expertise in LLMs, embeddings, vector search, prompt engineering, and RAG pipelines.
  • Proficiency with cloud AI platforms: Azure OpenAI, AWS Bedrock (Claude, Sonnet), GCP Vertex AI.
  • Experience with agent orchestration frameworks: LangChain, LangGraph, CrewAI, AutoGen, or equivalent Agentic AI frameworks.
  • Strong understanding of MCP (Model Context Protocol), A2A protocols, and multi-agent system design.
  • Familiarity with browser/desktop automation tools (Playwright, Selenium) as AI agent execution layers for legacy claims system navigation.
  • Familiarity with secure API design, OAuth2/JWT, enterprise integration patterns, and EDI transaction sets (X12 837/835/270/271/276/277).

Domain Skills

  • Deep understanding of end-to-end healthcare claims operations: claim submission, edits, adjudication, pricing, payment, adjustment, appeals, grievances, and overpayment recovery.
  • Strong knowledge of pre-pay/post-pay review, DRG validation, CPT/ICD-10/HCPCS code editing, COB, subrogation, and FWA detection methodologies.
  • Experience with claims processing platforms and systems (QNXT, Facets, Amisys, HealthRules Payer, CSC/DXC) and provider data management.
  • Understanding of healthcare financial models: PM

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