Remote AVP, Claims & Configuration Leadership

Prime Therapeutics; Annapolis (MD); Remote; USD 164,000 - 279,000; Full time

Job summary

Prime Therapeutics, a leader in pharmacy benefits, seeks an AVP of Claims & Configuration for remote leadership in Annapolis area. Lead claims adjudication, benefit configuration, and network operations, driving strategy, governance, and client satisfaction across platforms.

Responsibilities include guiding cross-functional teams, modernizing processes, ensuring compliance, and delivering scalable solutions in a regulated PBM environment. This is a senior, remote-capable role.

Qualifications

• Bachelor’s degree or equivalent combination of education and/or work 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 sponsorship.

Responsibilities

• Lead cross-functional teams responsible for claims adjudication, benefit configuration, testing, and production support.
• Drive modernization and continuous improvement to enhance operational efficiency and customer experience.
• Own strategy, roadmap, and governance for pharmacy claims adjudication and benefit configuration.
• Oversee interpretation and implementation of client benefit plans and pricing within claims systems.
• Collaborate with stakeholders to prioritize enhancements and drive operational transformation.
• Establish and monitor performance, quality, and regulatory compliance metrics.

Skills

Leadership

Executive communication

Regulatory knowledge

Strategic thinking

Education

Bachelor’s degree or equivalent

HS diploma or GED

Tools

PBM platforms

Benefit configuration systems

Job description

Prime Therapeutics, a leader in pharmacy benefits, seeks an AVP of Claims & Configuration for remote leadership in Annapolis area. Lead claims adjudication, benefit configuration, and network operations, driving strategy, governance, and client satisfaction across platforms.

Responsibilities include guiding cross-functional teams, modernizing processes, ensuring compliance, and delivering scalable solutions in a regulated PBM environment. This is a senior, remote-capable role.