Role overview

Qualifications

Bachelor's degree in Business, Healthcare Administration or related area of study
12 years of work experience in project management, portfolio management or operations
8 years of leadership/people management experience
Demonstrated ability to communicate effectively, both verbal and written

Responsibilities

Define and lead the multi-year claims technology and capability strategy
Lead and communicate the enterprise vision for claims block
Establish clear delivery boundaries and expectations in partnership with account management
Drive education, communication, and adoption strategies across business units

Key facts

Remote from: United States
Full time
Expert & Leadership (>10 years)
English

Hard skills

Project Management Business Operations Capacity Planning Process Improvement Risk Management Stakeholder Engagement Pharmacy Benefit Management Meeting Facilitation Conflict Management

Other skills

Strategic Thinking
Leadership
Analytical Skills
Communication
Problem Solving

About the company

Prime Therapeutics

Insurance

Everything we do is connected to helping people get the medicine they need to feel better and live well. It’s meaningful work and we’ve been doing it for over 24 years. In the pharmacy benefit management (PBM)industry, we’re different. We’re owned by 18 not-for-profit Blue Cross and Blue Shield health plans. This allows us to control costs and empower our employees to put members first. It’s a successful combination. We have the lowest pharmacy trend in the industry and serve 28+ million members throughout the US. In addition to core PBM services, we work closely with our clients to implement the right benefit design, clinical and specialty programs, formulary and networks. A few key products: • NetResults™ • Specialty Drug Management • Best in Care™ • GuidedHealth® • Advanced Fraud, Waste and Abuse: Member and Prescriber Investigations • Prime Analytics™ • CareCentered Contracting™Controlled Substance Management Program Join us! Prime is always looking for smart, purposeful people to join our team. We’re growing fast which means there are plenty of opportunities to advance and grow in your career. At the same time, Prime supports flexibility and offers generous PTO so you can enjoy an enviable work/life balance. We’re a privately held company -big enough to make a difference and small enough for you to have an impact. Prime’s recruiting team will only contact you via phone call or through a corporate email address. Do not respond to suspicious emails or social media messages. If you have questions or are skeptical about any follow-up communications, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.

Company details

Company typeLarge

IndustryInsurance

Company size1001 - 5000

Links

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Job description

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

AVP Claims Block Owner - Remote

Job Description

The AVP Claims Block Owner is responsible for defining and driving the enterprise vision and multi-year strategy for the claims block, ensuring alignment across key stakeholders. This role partners cross-functionally to identify improvement opportunities, set realistic delivery expectations, and lead large-scale initiatives that enhance claims capabilities, technology, and operational efficiency. This position oversees development and management of the business value case to support strategic investment in the roadmap.

Responsibilities

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

Minimum Qualifications

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

Additional Qualifications

Demonstrated ability to communicate effectively, both verbal and written, and the proven ability to work effectively with all organizational levels and external contacts
Strong strategic-thinking, analytic, and problem-solving skills
Excellent facilitation, presentation, and consultative skills; skilled at managing meetings and listening with the ability to interpret information into consistent and concise actions that drive results
Ability to effectively drive business and lead transformation in a dynamic and complex operating environment
Strong conflict management skills with ability to influence and drive stakeholders to most impactful outcomes
Understanding of adjudication engines and technical risk management

Preferred Qualifications

Master of Business Administration
Pharmacy Benefit Management or healthcare experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job

Potential pay for this position ranges from $164,000.00 - $279,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.  

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.

Positions will be posted for a minimum of five consecutive workdays.