Senior Vice President, Claims Services and Solutions
New
J
JobgetherHealthcare Payer Claims
Based in the United StatesFull-TimeVp
Salary not disclosed
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Job Details
- Experience
- 15+ years of progressive experience in healthcare payer claims; 10+ years of leadership experience in claims operations
- Required Skills
- Financial ManagementClient relationship management
Requirements
- 15+ years of progressive experience in healthcare payer claims, including processing, adjudication, quality, and productivity.
- 10+ years of leadership experience in claims operations or transformation within a healthcare payer BPO or managed services environment.
- Meaningful experience supporting California healthcare payer markets, including Medi-Cal programs and managed care organizations.
- Extensive end-to-end knowledge of claims processes, including intake, workflow management, adjudication, and quality assurance.
- Proven executive-level client relationship experience, including managing steering committees and strategic account management.
- Experience contributing to business growth through RFPs, RFIs, solution design, and finalist presentations.
- Strong financial and operational management capabilities, including labor utilization, staffing economics, and margin management.
- Ability to translate complex claims operating requirements into technology, workflow, and automation solutions.
- Demonstrated ability to lead large, complex, multi-client operations while balancing service quality and financial performance.
- Exceptional executive communication and presentation skills with the credibility to engage senior leaders.
Responsibilities
- Provide overall executive leadership for the healthcare payer Claims Services organization, establishing strategic direction and performance standards.
- Build and scale a high-performing, multi-client claims operating model covering the full lifecycle from claim receipt through final disposition.
- Drive operational excellence across quality, turnaround time, productivity, inventory, and client service-level commitments.
- Lead operational turnaround and stabilization initiatives for complex, underperforming, or high-risk claims environments.
- Partner with Technology and Product leadership to translate claims requirements into workflow, automation, and AI-enabled quality solutions.
- Lead executive-level client relationships, including quarterly business reviews, steering committees, and escalation management.
- Contribute to business growth by supporting RFPs, solution design, staffing models, and pricing strategies.
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