AVP Claims & Configuration (Fully Remote)

Prime Therapeutics; United States; Remote; USD 180,000 - 240,000; Full time

Job summary

Prime Therapeutics is a PBM focused on reimagining pharmacy solutions to simplify healthcare. The company fosters a purpose-driven, inclusive culture and is an equal opportunity employer.

Prime Therapeutics seeks a senior operations leader to drive claims adjudication, benefit configuration, and network operations while ensuring compliance and scalability across programs. The role emphasizes modernization, governance, and strategic oversight to meet regulatory requirements and improve efficiency

Qualifications

• 12+ years in PBM or healthcare operations.
• 8+ years of leadership experience.
• Expertise in claims platforms and regulatory requirements.

Responsibilities

• Lead claims adjudication, benefit configuration, and network operations.
• Ensure accurate, compliant, and scalable pharmacy benefit programs.
• Drive modernization and operational efficiency initiatives.
• Oversee strategy, governance, and regulatory compliance.

Skills

PBM operations

Leadership

Regulatory compliance

Claims platforms

Job description

• Lead claims adjudication, benefit configuration, and network operations.
• Ensure accurate, compliant, and scalable pharmacy benefit programs.

Key Responsibilities:

• Drive modernization and operational efficiency initiatives.
• Oversee strategy, governance, and regulatory compliance.

Qualifications:

• 12+ years in PBM or healthcare operations.
• 8+ years of leadership experience.
• Expertise in claims platforms and regulatory requirements.

Prime Therapeutics

Prime Therapeutics is a pharmacy benefit manager (PBM) focused on reimagining pharmacy solutions to simplify healthcare. The company fosters a purpose-driven, inclusive culture and is an equal opportunity employer.