Remote AVP, Claims & Configuration Leader

Prime Therapeutics; Little Rock (AR); Remote; USD 164,000 - 279,000; Full time

Job summary

Prime Therapeutics is recruiting an Associate Vice President for Claims & Configuration to lead claims adjudication, benefit configuration, and network operations. You will drive modernization, ensure compliant administration of pharmacy programs, and oversee stakeholder-aligned governance.

The role requires extensive PBM experience, executive presence, and strong communication with cross-functional teams. Remote work is available with national scope across the United States.

Qualifications

• Bachelor’s degree in Business, Health Care Administration, or related field.
• 12 years of work experience in PBM, health plan, or healthcare operations, including large scale transformations.
• 8 years of leadership/people management experience.
• Must be eligible to work in the United States without visa or residency sponsorship.

Responsibilities

• Lead cross-functional teams responsible for claims adjudication, benefit configuration, testing, and production support.
• Drive modernization and continuous improvement initiatives to enhance efficiency, scalability, accuracy, and customer experience.
• Own strategy, roadmap, and governance for claims adjudication and benefit configuration capabilities.
• Oversee interpretation and implementation of client benefit plans and pricing within claims processing systems.
• Collaborate with internal partners to prioritize enhancements and drive operational transformation for tech changes.
• Establish and monitor KPIs for accuracy, quality, compliance, and service excellence.
• Lead initiatives to simplify processes, reduce risk, and address technical debt across ecosystems.
• Develop capability through talent management, budgeting, and leadership of teams.
• Other duties as assigned.

Skills

Executive leadership

Communication skills

Stakeholder management

Regulatory knowledge

Problem-solving

Education

Bachelor’s degree or higher in Business/Healthcare Administration

HS diploma or GED

Tools

PBM platforms

Claims adjudication platforms

Benefit configuration systems

Job description

Prime Therapeutics is recruiting an Associate Vice President for Claims & Configuration to lead claims adjudication, benefit configuration, and network operations. You will drive modernization, ensure compliant administration of pharmacy programs, and oversee stakeholder-aligned governance.

The role requires extensive PBM experience, executive presence, and strong communication with cross-functional teams. Remote work is available with national scope across the United States.