Vice President of Claims

Job Summary

A company is looking for a Vice President, Claims to lead health plan operations.

Key Responsibilities

• Lead teams in the end-to-end processing of medical and pharmacy claims
• Ensure compliance with contractual agreements and applicable regulations
• Develop strategies to optimize claims operations and enhance payment integrity programs

Required Qualifications

• 15+ years of experience in health plan operations with a focus on self and level funded plans
• Deep subject matter expertise in medical claims
• Experience in project planning and execution
• Working knowledge of network and provider contracts
• Experience in leading and developing front-line supervisors and managers