Remote AVP, Claims & Configuration Leader

PRIME Therapeutics; United States; Remote; USD 164,000 - 279,000; Full time

Job summary

Prime Therapeutics is seeking an Associate Vice President to lead Claims & Configuration. You will drive strategic leadership, operational performance, and modernization across claims adjudication and configuration, ensuring compliant, scalable administration of pharmacy benefit programs.

You will oversee interpretation of client benefit plans, collaborate with senior leaders, and establish KPIs to measure quality, risk, and financial outcomes while guiding high-performing teams through

Qualifications

• Bachelor’s degree in Business, Health Care Administration, or related field or equivalent experience.
• 12 years of work experience in PBM, health plan, or healthcare operations.
• 8 years of leadership/people management experience.
• Eligible to work in the United States without visa or sponsorship.

Responsibilities

• Lead cross-functional teams responsible for claims adjudication, benefit configuration, testing, and production support.
• Drive modernization and continuous improvement to enhance efficiency, accuracy, and customer experience.
• Own strategy, roadmap, and governance for claims adjudication and configuration capabilities.
• Oversee interpretation and implementation of client benefit plans and pricing within claims processing systems.
• Collaborate with partners to prioritize enhancements and drive operational transformation.

Skills

Leadership

Communication

Education

Bachelor’s degree in Business/Healthcare Administration

Tools

PBM platforms

Claims processing systems

Job description

Prime Therapeutics is seeking an Associate Vice President to lead Claims & Configuration. You will drive strategic leadership, operational performance, and modernization across claims adjudication and configuration, ensuring compliant, scalable administration of pharmacy benefit programs.

You will oversee interpretation of client benefit plans, collaborate with senior leaders, and establish KPIs to measure quality, risk, and financial outcomes while guiding high-performing teams through