Payer Strategy Lead

About RISA

Healthcare regulation is accelerating faster than payer execution capacity. Prior authorization backlogs leave millions of patients in administrative purgatory. CMS mandates are rewriting the rules of data exchange. And somewhere between policy language and operational reality, the system breaks down.

RISA is building the execution layer for healthcare administration—the infrastructure that makes compliance and execution real. We’re not another point solution or legacy clearinghouse update. We’re becoming embedded in how healthcare actually runs, translating regulation into scalable, operational workflows that move trillions of dollars through the system.

Our approach is simple: build with payers, not around them.

Role Overview

This is not a traditional partnerships or sales role.

As Head of Payer Relations / Payer Strategy Lead, you will be RISA’s primary interface into payer strategy, operations, and policy execution. You will leverage your existing payer network to establish and deepen strategic relationships while translating regulatory intent into practical, scalable workflows that RISA can power.

You’ll operate at the intersection of regulation, technology, and real-world execution—ensuring RISA’s platform aligns with how payers are actually operationalizing CMS mandates, not how they’re written on paper.

Can Skip?Your mission: ensure RISA becomes infrastructure, not software.

Key Outcomes & Responsibilities

1. Payer Relationship Development

Leverage existing relationships with national and regional payers across Commercial, Medicare Advantage, and Medicaid markets to establish trusted working- and leadership-level partnerships. Serve as RISA’s primary point of contact for payer-side strategy, operations, and policy discussions, turning early engagement into long-term, system-level collaboration across organizations managing 100M+ covered lives.

2. Regulatory & Policy Intelligence

Develop a deep, current understanding of how payers are interpreting, sequencing, and operationalizing CMS mandates, including CMS-0057-F, prior authorization reform, interoperability, and transparency rules. Track real execution timelines, dependencies, and constraints—not just policy language—and continuously feed this intelligence into RISA’s product strategy, architecture, and roadmap.

3. Operational Streamlining & Payer Interface Enablement

Work directly with payer teams to streamline operational touchpoints where RISA interfaces with payer systems, including:

• Prior authorization workflows

• Eligibility verification and benefits (EV-BV) responses

• Coverage rules, medical necessity criteria, and exception handling

• Policy and guideline updates

Reduce friction, ambiguity, and latency in payer–provider–platform interactions, positioning RISA as a neutral execution layer rather than another vendor.

4. Capability–Requirement Intersection

Identify and define the intersection between:

• RISAs platform capabilities (automation, AI agents, workflow orchestration, traceability)

• Payer operational needs, compliance requirements, and real-world constraints

Surface opportunities where RISA can replace manual processes, standardize execution, and become essential infrastructure embedded in payer operations.

5. Internal Translation & Influence

Act as the translator between payer reality and RISA’s internal teams across product, engineering, and go-to-market. Shape product requirements, integration priorities, and positioning based on real payer needs—not assumptions. Influence how RISA presents itself to the market: as execution infrastructure that increases payer capability, not technology they must manage.

Ideal Background

• Deep experience working with or within payer organizations (health plans, PBMs, Medicare Advantage, Medicaid programs)

• Strong existing relationships with payer leaders across policy, operations, utilization management, or innovation teams

• Firsthand understanding of prior authorization, utilization management, EV-BV, and policy rollout challenges

• Technical fluency in healthcare interoperability standards, including FHIR, X12 transactions, HL7, and CMS Da Vinci implementation guides

• Comfort operating at the intersection of regulation, operations, and technology

• Ability to navigate ambiguity and help define a category, not just execute within one

• Executive presence and ability to translate complex infrastructure into strategic business value

Why This Role Matters

CMS mandates have created a market opportunity that didn’t exist 18 months ago. Every payer relationship you build doesn’t just grow revenue—it rewrites how prior authorizations and administrative workflows function for millions of patients waiting for care.

You’ll skip the legacy EDI playbook and build modern healthcare infrastructure from first principles. You’ll help define how an entire industry operationalizes its future. And you’ll do it with a team that believes healthcare administration can actually work better.

This is category-defining work. Come build it with us.