Vice President of Health Plan Claims and Operations
2 days ago
We are seeking a highly skilled and experienced Vice President of Health Plan Claims and Operations to join our team at Prime Healthcare Management, Inc. This key leadership role will be responsible for developing and executing Claim Operations strategies, end-to-end Claim process automation, optimization, and management.
Key Responsibilities- Develop and execute Claim Operations strategies to improve the quality and minimize process cost of Claims for all Prime Healthcare's self-insured Employee Health Plans.
- Lead the development and implementation of Claim process automation, optimization, and management initiatives.
- 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.
- Ensure timely notification of changes in process or procedures that impact TPA and Health Plan functions.
- Masters Degree in Business Management, Healthcare Administration, or other relevant fields.
- Minimum of seven (7) to ten (10) years prior work experience in Claims Operations and Health Plan Strategy, in a Managed Care, Self-Funded, or hospital setting.
- Strong analytical skills with emphasis on generation and utilization of data to drive operational and financial performance.
- Ability to work in a complex, rapidly evolving environment with multiple internal and external entities and boundaries.
- Strong interpersonal skills, problem-solving, and project/time management essential.
- Ability to develop presentations to all levels using Microsoft Office applications.
- Strong knowledge of medical coding (ICD-10, HCPCs/CPT, etc.).
- Certified Professional Coding Certification, AIC, ARM, or equivalent.
- Familiarity with multiple Business Intelligence software systems and daily usage of at least one.
Prime Healthcare Management, Inc. offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.
A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $150,000.00 to $230,000.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire and will be dependent on a wide range of factors, including but not limited to geographic location, skill set, experience, education, credentials, and licensure.
Additionally, employees in this position may be eligible to participate in the Company's annual discretionary bonus program. Discretionary bonuses, if any, are based on a number of factors, which include but are not limited to individual and Company performance.
We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law:
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