RISA · 22 hours ago
Payer Strategy Lead
Washington, DC
Full-time
Onsite
Senior LevelRISA is a company focused on transforming healthcare administration by creating an execution layer that aligns with regulatory mandates. The Payer Strategy Lead will serve as the primary interface for payer strategy and operations, leveraging existing relationships to facilitate strategic partnerships and streamline operational workflows in compliance with CMS mandates.
Artificial Intelligence (AI)Enterprise Software
Responsibilities
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
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
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
Identify and define the intersection between: RISA’s platform capabilities (automation, AI agents, workflow orchestration, traceability) and 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
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
Qualification
Required
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
Company
RISA
RISA’s raison d’être (reason of existence): Making Institutions Win, starting in oncology.
Founded in 2024
11-50 employees
Funding
Current Stage
Early StageTotal Funding
$14.6MKey Investors
Binny Bansal
2026-01-13Series A· $11.1M
2025-04-17Seed· $3.5M
Leadership Team
Kshitij Jaggi
CEO
Recent News
2026-01-18
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2026-01-16
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