Executive Director of Health Plan Operations

2 weeks ago


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

We are seeking a highly skilled and experienced professional to lead our Health Plan Claims and Operations team as Vice President. The successful candidate will be responsible for developing and executing Claim Operations strategies, automating and optimizing the end-to-end Claim process, and identifying opportunities to improve quality and reduce costs.

Key Responsibilities
  • Develop and execute Claim Operations strategies to improve quality and reduce costs
  • Automate and optimize the end-to-end Claim process
  • Identify opportunities to improve quality and reduce costs through data analysis and process improvement
  • Provide strategic leadership and development of the Claims Department and its employees
  • Collaborate with Network Development, Provider Affiliation, and Member Relations to ensure data integrity and drive financial and operational value
Requirements
  • Master's Degree in Business Management, Healthcare Administration, or relevant field
  • Minimum 7-10 years of experience in Claims Operations and Health Plan Strategy
  • Strong analytical skills with emphasis on data-driven decision making
  • Ability to work in a complex, rapidly evolving environment with multiple internal and external entities
  • Strong interpersonal skills, problem-solving, and project/time management
What We Offer

Prime Healthcare offers a competitive compensation package, including a comprehensive benefits program, tuition reimbursement, and opportunities for professional growth and development.



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