Remote AVP, Claims & Configuration Strategy

Prime Therapeutics; Phoenix (AZ); A distancia; USD 164.000 - 279.000; Jornada completa

Descripción de la vacante

Prime Therapeutics, a leading national PBM, seeks an Associate Vice President, Claims & Configuration, to lead strategy and operations for claims adjudication, benefit configuration, and network operations in a remote-capable role.

You will drive modernization, partner with cross-functional leaders, govern roadmaps, ensure regulatory compliance, and deliver data-driven improvements that enhance accuracy, speed, and client satisfaction.

Formación

• 12 years of work experience in PBM, health plan, or healthcare operations, including large-scale platform enabled transformations
• 8 years of leadership/people management experience
• Must be eligible to work in the United States without the need for work visa or residency sponsorship

Responsabilidades

• Lead cross-functional teams responsible for claims adjudication, benefit configuration, testing, and production support
• Drive modernization and continuous improvement initiatives that enhance operational efficiency, scalability, accuracy, data-driven decision making and customer experience
• Own execution of the strategy, roadmap, and governance for pharmacy claims adjudication and benefit configuration capabilities, ensuring alignment with business, client, and regulatory requirements
• Oversee the accurate interpretation and implementation of client benefit plans, formularies, accumulators, pricing, utilization management rules, and clinical programs within claims processing systems
• Collaborate with key internal partners and business leaders to prioritize enhancements, drive operational transformation to support technology changes, and deliver strategic business outcomes
• Establish and monitor key performance, quality, compliance, and financial metrics to ensure claims adjudication accuracy, configuration integrity, service excellence, and regulatory compliance
• Lead operational initiatives to simplify processes, reduce operational risk, improve speed-to-market, and address technical debt across claims and configuration ecosystems
• Develop organizational capability through talent management, succession planning, budget oversight, and leadership of high-performing teams focused on operational excellence
• Other duties as assigned

Conocimientos

Strategic leadership

People management

Cross-functional collaboration

Regulatory compliance

Executive communication

Project management

Educación

Bachelor’s degree in Business/Health Care Administration

HS diploma or equivalent

Herramientas

PBM platforms

Benefits configuration systems

Descripción del empleo

Prime Therapeutics, a leading national PBM, seeks an Associate Vice President, Claims & Configuration, to lead strategy and operations for claims adjudication, benefit configuration, and network operations in a remote-capable role.

You will drive modernization, partner with cross-functional leaders, govern roadmaps, ensure regulatory compliance, and deliver data-driven improvements that enhance accuracy, speed, and client satisfaction.