Director, Health Care Strategy & Plan Economics

Victra is Verizon’s largest premium retailer in the United States. We thrive on collaboration, innovation, and performance. Our mission is to “Connect technology to life in a trustworthy, fun, and profitable way”.We work closely with Verizon and our brand partners to deliver exceptional product offerings, promotions, and campaigns that drive in-store traffic and revenue.

Victra is self-insured for medical benefits, administering claims through a third-party administrator (TPA) and pharmacy benefits through a pharmacy benefit manager (PBM), with stop-loss reinsurance covering catastrophic claims. This role owns the financial performance of that program end to end — the plan's single largest controllable SG&A line outside of labor. The successful candidate will function as an internal actuary, contract negotiator, and plan-design strategist rolled into one, partnering with Finance and HR/Total Rewards to re-underwrite how Victra buys and manages health care.

This is a self-funding role expected to identify, execute, and validate savings that are a multiple of its own fully-loaded cost within the first 12–18 months, and to build a durable cost-management discipline thereafter.

Initially an individual contributor, this role may scale to lead 1–2 analysts focused on benefits analytics and vendor management as the program matures.

• Own the TPA relationship: performance guarantees, administrative fee benchmarking, claims-payment accuracy audits, and periodic competitive RFPs (typically every 3–5 years) to keep fees and service levels market-tested.
• Commission and act on independent claims audits; recover over payments and correct systemic adjudication errors.
• Drive dependent eligibility audits, coordination-of-benefits recovery, and subrogation/third-party liability recovery to eliminate ineligible and duplicate spend.

• Negotiate and audit PBM contracts for full pricing transparency: pass-through vs. spread pricing, 100% rebate pass-through, guaranteed effective rates, and audit rights — aligned with 2026 PBM reform and DOL fee-disclosure rules that raise ERISA fiduciary expectations for plan sponsors.
• Manage formulary strategy, specialty/biosimilar utilization, and site-of-care steerage for infusions and high-cost specialty drugs.
• Build and continuously refine Victra's GLP-1 (weight-loss/diabetes) coverage strategy — eligibility criteria, utilization management, lifestyle-program pairing, and vendor point-solution evaluation — given GLP-1s are now one of the fastest-growing cost drivers for self-insured plans nationally.
• Run PBM RFPs on a disciplined cadence (typically every 2–3 years) using independent pricing benchmarks.

• Redesign benefit tiers, networks, and steerage incentives (reference-based pricing, narrow/tiered networks, centers of excellence for high-cost procedures, bundled-payment arrangements) to shift utilization toward high-value care without shifting unreasonable cost to associates.
• Evaluate and rationalize point solutions (MSK, virtual care, fertility, diabetes management, second-opinion services) for real ROI versus fee-stacking.
• Partner with HR/Total Rewards on plan design changes that balance cost, competitiveness in a large hourly-retail workforce, and ACA compliance (eligibility measurement periods, affordability).

• Own the annual stop-loss/reinsurance placement — specific and aggregate attachment points, captive or level-funding alternatives — in partnership with Treasury and outside brokers/actuaries.
• Build and maintain a high-cost claimant / large-case…