Vice President Health Plan Claims and Operations
Company: Prime Healthcare
Posted on: August 1, 2022
The Vice President of Health Plan Claims and Operations is
responsible for the development and execution of Claim Operations
strategies, end-to-end Claim process automation, optimization and
management, 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. Through
in-depth audit and review of Claims data, the VP will identify
financial savings across all aspects of the Employee Health
The VP of Health Plan Claims and Operations will provide strategic
leadership and development of the Claims Department and its
employees, as well as collaborate with Network Development,
Provider Affiliation and Member Relations, Contracting, and
Benefits Administration to ensure data integrity and to drive
financial and operational value across Employee Health Plans to
maximize benefit coverage while containing cost.
The VP of Health Plan Claims and Operations will partner with local
C-Suites and Hospital Administration to execute goals and plans of
the Employee Health Plans. Through inter-professional
collaboration, The VP will ensure that TPA and Health Plan are
notified in a timely fashion of any changes in process or
procedures which would impact their functions.
--- Master's Degree in Business Management, Healthcare
Administration, or other relevant fields.
--- A 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 is required.
--- 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
--- Ability to develop presentations to all levels using Microsoft
--- Strong knowledge of medical coding (ICD-10, HCPCs/CPT,
--- Certified Professional Coding Certification, AIC, ARM, or
--- Familiarity with multiple Business Intelligence software
systems and daily usage of at least one.
Keywords: Prime Healthcare, Chino , Vice President Health Plan Claims and Operations, Executive , Chino, California
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