- Long Beach, California, United States
- Full-time · Vp
- $260K–$325K per year
- 10–15 years
Leads the strategy, performance, and modernization of claims, configuration, provider data, payment integrity, and capitation operations to build a high-performing, compliant, and scalable operating model that improves accuracy, timeliness, affordability, provider experience, and member outcomes.
Compensation
Base Pay Range: $260,000-$325,000, Salary + Incentive Plan
Responsibilities
- Leads a multi-disciplinary organization across claims intake, adjudication, configuration, provider data operations, payment integrity, capitation, and operational support
- Owns end-to-end operational accuracy, timeliness, compliance, and control performance across claims and provider operations
- Leads the evolution and transformation of claims and provider operations through workflow simplification, delivery model optimization, and automation
- Partners closely with IT, EDI Operations, Finance, Network Management, Compliance, Clinical, Appeals and Grievances, and other business leaders to optimize claims system configuration and provider data integrity
- Drives affordability through payment integrity and disciplined claims controls
Requirements
- Bachelor's Degree
- MBA
- Nice to have: AI
- Nice to have: automation
- Nice to have: predictive analytics