Staff VP Digital Claims Operations

Elevance Health; Chicago (IL); Hybrid; USD 202,000 - 348,000; Full time

Job summary

Elevance Health seeks a Staff VP for Digital Claims Operations to lead the digital transformation of claims processes across Health Benefits Operations. Reporting to Claims Operations, this leader will blend strategy, analytics, and technology implementation to boost efficiency, accuracy, and service quality, while advancing AI, automation, and end-to-end solutions.

The role requires strong leadership, cross‑functional collaboration, and a track record of delivering measurable outcomes in a

Qualifications

• Requires a BA/BS in Information Technology, Computer Science or related field and a minimum of 15 years of claims operations management and digital transformation.
• Proven leadership and team management skills with strong analytical and communication abilities; deep understanding of industry regulations and compliance standards.
• Advanced degree in business, technology, analytics, healthcare administration, or a related field; experience leading AI, automation, analytics, and change in a matrixed organization.

Responsibilities

• Digital claims strategy and transformation: translate objectives into sequenced initiatives, investment choices, and measurable outcomes.
• Claims analytics and enterprise partnership: connect operational questions to data, insights, decisions, and actions; support actuarial reserving and Cost of Care.
• Digital operations and end‑to‑end solution delivery: oversee governance, requirements through implementation, adoption, and optimization.
• Innovation, pilots, and performance management: design pilots with hypotheses, measures, controls, and scale decisions; drive productivity and service quality.
• Technology enablement and stakeholder engagement: ensure upgrades, integration, operating readiness, and governance.
• Compliance and risk: embed policies, controls, audit readiness, privacy, security, and risk-management expectations.
• People leadership: build a high-performance team, drive development, succession planning, and cross-functional capability.

Skills

AI leadership

Automation

Analytics

Process optimization

Budget management

Executive leadership

Healthcare industry experience

Education

BA/BS in IT or CS

Job description

Staff VP Digital Claims Operations

Anticipated End Date: 2026-11-30

Location: May be located in any Elevance Health PulsePoint office preferably in Indianapolis, IN, Atlanta, GA, Mason, OH, Richmond, VA, Norfolk, VA, Chicago, IL or Woodland Hills, CA. Alternate locations may be considered if candidates reside within a commuting distance from an office.

This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work‑life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Summary

The Staff Vice President, Digital Claims Operations is responsible for driving the digital transformation of claims processes within Health Benefits Operations. Reporting to the Vice President, Claims Operations, this leader integrates strategic planning, process optimization, analytics, and technology implementation to enhance operational efficiency, processing accuracy, and service quality across claims management. The leader develops and executes a digital claims strategy aligned with company objectives and provides hands‑on leadership for transformation initiatives involving AI, automation, advanced analytics, and end‑to‑end solution delivery. Serving as the claims analytics domain lead, the executive supports enterprise actuarial reserving and Cost of Care initiatives while managing the intersection of operations, analytics, and technology with deep claims expertise.

Leadership and Culture

The successful executive will combine enterprise perspective, disciplined execution, innovation, and strong stakeholder leadership. They will build a collaborative, high‑performance team; identify and develop talent; clarify accountability; and foster an environment grounded in trust, inclusion, continuous learning, and measurable outcomes.

Strategic Mandate and Outcomes

Develop and execute a digital claims strategy that aligns with company objectives and advances operational, financial, and service outcomes. Integrate strategic planning, process optimization, analytics, AI, automation, and technology implementation into a cohesive transformation agenda. Lead the claims analytics domain and support enterprise actuarial reserving, Cost of Care, and other priority business initiatives. Oversee digital claims operations and the delivery of end‑to‑end solutions that improve efficiency, accuracy, productivity, and service quality. Design and implement pilots to test strategies, validate value, assess scalability, and accelerate adoption of innovative capabilities. Ensure digital claims operations meet applicable regulatory, compliance, control, and risk‑management requirements.

Illustrative Measures of Success

A clear digital claims roadmap is established, aligned to business priorities, and translated into accountable delivery plans. AI, automation, analytics, and process changes produce measurable improvements in productivity, quality, accuracy, and service performance. Pilots are designed with defined hypotheses, performance measures, governance, and decisions regarding scale, refinement, or discontinuation. Claims analytics effectively support operational decisions, actuarial reserving, and Cost of Care priorities. End‑to‑end solutions are delivered with strong operating readiness, adoption, stakeholder alignment, and sustained benefit realization. Budgets, risks, dependencies, and cross‑departmental commitments are managed with transparency and discipline. Digital claims operations consistently meet regulatory and compliance expectations.

Position Responsibilities

Digital Claims Strategy and Transformation

Develop, communicate, and execute the digital claims strategy and transformation roadmap. Translate company objectives and claims priorities into sequenced initiatives, investment choices, operating changes, and measurable outcomes. Provide hands‑on leadership for transformation initiatives involving AI, automation, analytics, workflow redesign, and digital capabilities. Identify opportunities to simplify claims processes, reduce manual work, improve decision quality, and strengthen member and provider service.

Claims Analytics and Enterprise Partnership

Serve as the analytics domain lead for claims, connecting operational questions to data, insights, decisions, and actions. Support enterprise actuarial reserving and Cost of Care initiatives through claims domain expertise, analytics partnership, and operational insight. Lead the intersection of claims operations, analytics, and technology, ensuring solutions are grounded in business needs and claims realities. Partner with Finance, Actuarial, Analytics, Technology, and Claims leaders to define priorities, requirements, controls, and success measures.

Digital Operations and End‑To‑End Solution Delivery

Oversee digital operations to support efficient, accurate, and timely claims processing. Lead delivery of end‑to‑end solutions, from opportunity definition and requirements through implementation, adoption, performance monitoring, and optimization. Coordinate cross‑departmental projects, resolve dependencies, establish decision rights, and maintain accountability for commitments. Manage budgets and resource priorities to optimize value, delivery, and operational performance.

Innovation, Pilots, and Performance Management

Design and implement pilots to test strategies, workflows, analytical approaches, AI, automation, and other innovative technologies. Define pilot hypotheses, measures, controls, and scale decisions while balancing speed, risk, and operational readiness. Monitor performance metrics and use insights to drive productivity improvement, service quality, processing accuracy, and continuous improvement. Create feedback loops that strengthen models, automation, controls, processes, and frontline execution.

Technology Enablement and Stakeholder Engagement

Collaborate closely with IT and other departments to ensure seamless technology upgrades, implementations, integration, and operating readiness. Maintain strong stakeholder engagement to align objectives, surface tradeoffs, resolve barriers, and sustain adoption. Communicate priorities, progress, risks, and outcomes clearly to operational, technical, analytical, and executive audiences. Promote responsible use of AI and automation with appropriate governance, controls, monitoring, and accountability.

Compliance and Risk

Ensure regulatory compliance across digital claims operations and transformation initiatives. Embed applicable policies, controls, audit readiness, privacy, security, and risk‑management expectations into solution design and operating practices. Partner with Compliance, Legal, Risk, Technology, and Operations to identify, elevate, and resolve issues.

People Leadership

Lead and mentor a high‑performance team, fostering collaboration, accountability, innovation, and continuous learning. Identify talent and create development opportunities that build succession depth and future‑ready capabilities. Hire, train, coach, counsel, and evaluate the performance of direct reports. Build capability across claims operations, analytics, digital product leadership, process optimization, AI, automation, and change execution.

Position Requirements

• Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 15 years of claims operations management and digital transformation.
• Proven leadership and team management skills, strong analytical and communication abilities, and an in-depth understanding of industry regulations and compliance standards.

Preferred Skills, Capabilities, and Experiences

• Advanced degree in business, technology, analytics, healthcare administration, or a related field.
• Demonstrated experience leading AI, automation, analytics, process optimization, and technology-enabled change in a complex, matrixed organization.
• Experience managing budgets, cross‑functional portfolios, major implementations, and end‑to‑end solution delivery.
• Executive-level experience leading digital claims operations within a large healthcare enterprise.
• Experience supporting actuarial reserving, Cost of Care, payment integrity, or related financial and analytical priorities.
• Experience scaling AI and automation from pilot through production with strong governance, adoption, and benefit realization disciplines.
• Demonstrated success integrating claims operations, analytics, technology, product, provider data management and configuration, and change management into a cohesive operating model.

For candidates working in person or virtually in the below location(s), the salary range for this specific position is $202,000.00 to $348,450.00. Locations: Virginia, California, Illinois.

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level: Staff/Regional VP. Workshift: Job Family: CLM > Claims Support.

Elevance Health is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, and local laws.

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.