AVP, Claims & Configuration — Remote Strategy Leader

Prime Therapeutics; Lansing (MI); Remote; USD 164,000 - 279,000; Full time

Job summary

Prime Therapeutics is seeking an Associate Vice President, Claims & Configuration, to lead strategic and operational efforts in claims adjudication and configuration. This remote role oversees teams across operations and technology to ensure accurate, compliant administration of pharmacy benefit programs.

The position emphasizes modernization, governance, and client-focused performance, with a focus on hiring, budgeting, and leadership of high-performing teams for operational excellence.

Qualifications

• Bachelor’s degree in Business, Health Care Administration, or related area; HS diploma accepted.
• 12 years in PBM, health plan, or healthcare ops with large-scale transformations.
• 8 years of leadership/people management experience.
• Eligible to work in the United States without visa sponsorship.

Responsibilities

• Lead cross-functional teams for claims adjudication, benefit configuration, testing, and production support.
• Drive modernization and continuous improvement for efficiency, data-driven decisions, and customer experience.
• Own strategy, roadmap, and governance for claims adjudication and configuration capabilities.
• Oversee interpretation and implementation of client benefit plans, formularies, and pricing rules.
• Collaborate with leaders to prioritize enhancements and drive operational transformation.
• Establish KPIs for accuracy, quality, compliance, and service excellence.
• Lead initiatives to reduce risk and address technical debt across ecosystems.
• Develop organizational capability through talent management and budget oversight.

Skills

PBM experience

Leadership

Executive communication

Stakeholder management

Education

Bachelor’s degree in Business/Health Care Admin

Job description

Prime Therapeutics is seeking an Associate Vice President, Claims & Configuration, to lead strategic and operational efforts in claims adjudication and configuration. This remote role oversees teams across operations and technology to ensure accurate, compliant administration of pharmacy benefit programs.

The position emphasizes modernization, governance, and client-focused performance, with a focus on hiring, budgeting, and leadership of high-performing teams for operational excellence.