Chief Health Plan Operations Officer

6 days ago


Ontario, California, United States Prime Healthcare Full time
Job Summary

The Vice President of Health Plan Claims and Operations is a strategic leader responsible for developing and executing Claim Operations strategies, end-to-end Claim process automation, optimization, and management. This role involves identifying and leveraging technology and data to improve the quality and minimize process cost of Claims for all Prime Healthcare's self-insured Employee Health Plans.

Key Responsibilities
  • Develop and execute Claim Operations strategies to improve Claim process efficiency and reduce costs.
  • Collaborate with Network Development, Provider Affiliation, and Member Relations to ensure data integrity and drive financial and operational value across Employee Health Plans.
  • Partner with local C-Suites and Hospital Administration to execute goals and plans of the Employee Health Plans.
  • Design and implement operational improvements, performance management techniques, and metrics to drive business results.
  • Manage and optimize Claim process automation, including PDR's, Disputes, Appeals, and Recoveries.
Requirements

The ideal candidate will have significant experience in operations with self-funded health plans, including designing operational improvements, performance management techniques, and metrics. They will also have experience in claims, including PDR's, Disputes, Appeals, and Recoveries.

Prime Healthcare offers competitive compensation and amazing benefits to attract and retain top talent.



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