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 Plans.
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.