Remote AVP, Claims & Configuration Leader

Prime Therapeutics; Frankfort (KY); Remote; USD 164,000 - 279,000; Full time

Job summary

Prime Therapeutics is seeking an Associate Vice President of Claims & Configuration to lead claims adjudication, configuration, and network operations from a remote setting. You will drive modernization, governance, and client-focused outcomes in a highly regulated environment.

The role requires extensive PBM experience, strong leadership, and the ability to translate complex plans into scalable systems while delivering client value and financial performance.

Qualifications

• Bachelor's degree or equivalent with healthcare ops experience.
• 12 years in PBM/healthcare operations, incl. large-scale transformations.
• 8 years in leadership/people management.
• 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 and data-driven decisions.
• Own strategy, roadmap, and governance for claims adjudication and configuration.
• Oversee interpretation/implementation of client benefit plans and rules.
• Collaborate with partners to prioritize enhancements and drive transformation.
• Establish KPIs for quality, compliance, and financial performance.
• Lead initiatives to reduce risk and address technical debt across systems.
• Develop capability through talent management and leadership of teams.
• Other duties as assigned.

Skills

Leadership

Communication

Stakeholder management

Regulatory understanding

Operational excellence

Education

Bachelor's degree in Business, Health Care Administration, or related area

Tools

PBM platforms

Claims adjudication platforms

Job description

Prime Therapeutics is seeking an Associate Vice President of Claims & Configuration to lead claims adjudication, configuration, and network operations from a remote setting. You will drive modernization, governance, and client-focused outcomes in a highly regulated environment.

The role requires extensive PBM experience, strong leadership, and the ability to translate complex plans into scalable systems while delivering client value and financial performance.