Senior AVP: Claims & Configuration - Remote Leader

Prime Therapeutics; Columbus (OH); Remote; USD 164,000 - 279,000; Full time

Job summary

Prime Therapeutics is hiring an Associate Vice President, Claims & Configuration, to lead strategic direction, operational performance and continuous evolution of pharmacy benefit claims adjudication and configuration capabilities. This remote role drives modernization, governance and client satisfaction across a national footprint.

The role oversees complex benefit plans implementation, pricing and regulatory compliance while building high-performing teams and measuring KPIs for service quality

Qualifications

• Bachelor’s degree required or equivalent work experience in related field
• 12 years of PBM/healthcare operations experience including large-scale platform 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, accuracy and customer experience
• Own strategy, roadmap and governance for claims adjudication and configuration capabilities
• Oversee interpretation and implementation of client benefit plans, formularies, accumulators and pricing

Skills

Leadership/people management

PBM experience

Regulatory awareness

Executive communication

Education

Bachelor’s degree in Business, Health Care Administration, or related area of study

HS diploma or equivalent GED

Job description

Prime Therapeutics is hiring an Associate Vice President, Claims & Configuration, to lead strategic direction, operational performance and continuous evolution of pharmacy benefit claims adjudication and configuration capabilities. This remote role drives modernization, governance and client satisfaction across a national footprint.

The role oversees complex benefit plans implementation, pricing and regulatory compliance while building high-performing teams and measuring KPIs for service quality