Engineering the Future of Payment Integrity: A Conversation with Alex Yanes, VP of Engineering

Building the Backbone of Modern Payment Integrity: Q&A with Alex Yanes

Amanda Bair: You’ve built SaaS products across healthcare tech for years. What drew you to payment integrity—and to this role?

Alex Yanes: What brought me here is the chance to innovate and transform. I’ve worked in environments with extremely tight SLAs, where billing accuracy directly affects operations. Payment integrity is a natural extension of that, making sure the books check out. But we’re also building software that can validate and improve the system at scale.

My background in machine learning plays a role, too. In previous roles, my work helped health systems decide where to build new hospitals and specialty centers, decisions involving billions of dollars based on massive data sets.

Now I look at billions of claims and think, why wouldn’t we let computers do what they do best? As long as we do it ethically and in ways where we can always check the math.

AB: What do engineering teams often misunderstand about the day-to-day world of payment integrity users?

AY: Engineers love clean problems. Payment integrity isn’t one.

Programmers want everything perfect and defined from the beginning. But when you’re dealing with finances—especially in healthcare—there’s always an exception. Add PHI protection, regulatory requirements, and operational realities. The complexities multiply quickly.

One key mindset shift is valuing incremental progress. Engineers solve problems all day, which means we fail a lot before we succeed. Delivering a key part of the solution is still a win.

It’s also important to understand the human behind the workflow. In the traditional approach, an auditor might only get through 10 or 15 cases in a day if they’re being thorough. Their diligence affects the health plan, providers, and ultimately members. We want to minimize abrasion for everyone—and the member is number one.

AB: How do you bring that empathy into engineering culture?

AY:  I remind the team: you go to the doctor, too. You’ve gotten an explanation of benefits. You’ve seen a bill that didn’t look right.

Those experiences anchor the mission. It’s about keeping billing aligned, ensuring providers are paid appropriately, and avoiding situations where money gets clawed back months later. When we build better systems, we improve experience across the entire healthcare ecosystem.

AB: What’s your philosophy for building healthcare technology where trust and security are non-negotiable?

AY: First and foremost: security. Client and member data have to be protected to the utmost.

From there, it’s about discipline and product thinking. My focus has been shifting from a services-heavy model to a true product-led approach. Building custom software for every client isn’t sustainable for either of us. We build a product that works across the market, then evaluate gaps through that lens.

Standardization is central to this tenet. If we build consistently, we avoid a single edge case leaking into the core product. You solve nine out of ten problems in a repeatable way and number nine becomes easy.

AB: What’s been one of the toughest engineering challenges here?

AY: Modernization at scale. When I joined, ClarisHealth had grown quickly, serving major payers, but still carried early-stage startup patterns.

My challenge focus has been evolving us into a true software company. That includes standard deployment models, shared architectures, and scalable processes that don’t require headcount to grow linearly with clients.

Technology should handle what it does best. Our people should focus on subject matter expertise and new value.

AB:  What shifts in payment integrity technology excite you most?

AY: Speed to value—and intelligent automation.

With a modern data foundation and standardized deployment, I see the industry moving beyond the idea that every use case requires every data element upfront.

I’m also excited about the platform ecosystem approach. We want our own AI capabilities, absolutely. But we also want to create a place where innovative technologies can integrate and expand what’s possible.

Automation is about craftsmanship. You solve a problem once. Then you automate it so you can work on the next, bigger problem.

AB: Anything people should know about your engineering team?

AY: They’re gritty. They’ve pushed through tough deadlines, adopted new technologies, and stayed committed.

What motivates me most is watching that team grow. When someone says, “That made my life easier,” you know you’re on the right path. They’re hungry to learn, and they trust the vision of where we’re going.

In a trillion-dollar industry where small improvements have a massive impact, that mix of discipline, empathy, and ambition is exactly what payment integrity demands.

Conclusion

Payment integrity may be measured in dollars recovered and errors prevented, but the foundation is rooted in engineering discipline: how systems are designed, how data is handled, and how consistently technology can deliver trust at scale.

That’s the through line in how Alex Yanes approaches his work. For him, innovation isn’t about chasing features. It’s about building a secure, repeatable foundation strong enough to support automation, AI, and whatever comes next—without losing sight of the people at the end of the process.

“The member is number one,” he says, a reminder that every claim, audit, and workflow ultimately traces back to a real healthcare experience. By combining product rigor with empathy and a long-term platform vision, his team is doing more than improving software. They’re helping to modernize how payment integrity operates.