AVP, Claims & Judi Strategy and Transformation - Remote

Prime Therapeutics LLC

Job Overview

Location

Home

Job Type

Full-time

Full Job Description

📋 Description

• Define and lead the multi-year claims technology and capability strategy, including roadmap development for claims platforms, capacity planning, prioritization of enhancements, and assessment and sunsetting of claims-adjacent systems to reduce complexity and improve efficiency in partnership with key stakeholders.
• Lead and communicate the enterprise vision for claims block, ensuring alignment to roadmap across business units and active engagement with peer block owners to identify gaps, challenge existing processes, and drive continuous improvement across claims capabilities.
• Establish clear delivery boundaries and expectations in partnership with account management, aligning on client commitments and operational feasibility.
• Drive education, communication, and adoption strategies across business units and functional teams, including the development of business case vision and value for investment.
• Partner with Claims Operations, Configuration Operations, and Strategic Solutions teams to lead large-scale, high-impact initiatives that improve claims outcomes and business performance.
• Assess and manage external partner impacts and dependencies, ensuring alignment with organizational capabilities, contractual obligations, and long-term strategic goals.
• Remain aware of leading-practice industry technologies, including AI, and ensure future-state roadmaps responsibly include leading-edge technological capabilities.
• Other duties as assigned.

🎯 Requirements

• Bachelor's degree in Business, Healthcare Administration or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or GED is required.
• 12 years of work experience in project management, portfolio management or operations.
• 8 years of leadership/people management experience.
• Must be eligible to work in the United States without the need for work visa or residency sponsorship.

🏖️ Benefits

• Potential pay for this position ranges from $164,000.00 - $279,000.00 based on experience and skills.
• Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer.
• We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
• Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Skills & Technologies

Remote

Degree Required

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Prime Therapeutics LLC

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About Prime Therapeutics LLC

Prime Therapeutics LLC is a pharmacy benefit management company founded in 1989 and headquartered in Eagan, Minnesota. It administers prescription drug plans on behalf of health plans, employers, and government programs, processing claims, negotiating rebates, managing formularies, and operating specialty pharmacies. Owned by a consortium of Blue Cross and Blue Shield plans, the company serves over 40 million members nationwide while focusing on cost control, clinical outcomes, and member safety.

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