Remote AVP, Claims & Configuration Leader

Prime Therapeutics; Boston (MA); Remote; USD 164,000 - 279,000; Full time

Job summary

Prime Therapeutics is seeking an Associate Vice President, Claims & Configuration for a remote role in the United States. You will lead strategic direction, oversee claims adjudication and benefit configuration, and drive modernization across operations, technology, and client services.

This senior role emphasizes governance, efficiency, and high-impact program leadership. Responsibilities include guiding cross-functional teams, implementing improvements, and ensuring regulatory compliance while

Qualifications

• Bachelor’s degree in Business, Health Care Administration, or related field, or equivalent.
• 12 years of work experience in PBM, health plan, or healthcare operations 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 responsible for claims adjudication, benefit configuration, testing, and production support.
• Drive modernization and continuous improvement initiatives for operational efficiency and customer experience.
• Oversee strategy, roadmap, and governance for claims adjudication and benefit configuration.
• Ensure accurate interpretation and implementation of client benefit plans and pricing within systems.
• Monitor KPIs for claims accuracy, configuration integrity, and regulatory compliance.
• Develop organizational capability through talent management and budgeting.

Skills

Leadership

Strategic thinking

Executive communication

Cross-functional collaboration

Education

Bachelor's degree

Tools

PBM platforms

Job description

Prime Therapeutics is seeking an Associate Vice President, Claims & Configuration for a remote role in the United States. You will lead strategic direction, oversee claims adjudication and benefit configuration, and drive modernization across operations, technology, and client services.

This senior role emphasizes governance, efficiency, and high-impact program leadership. Responsibilities include guiding cross-functional teams, implementing improvements, and ensuring regulatory compliance while