AVP, Claims & Judi Strategy and Transformation - Remote

AVP Claims Block Owner – Remote

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.

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 include:

• 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 sun setting 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 include:

• 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 include:

• 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 include:

• Master of Business Administration
• Pharmacy Benefit Management or healthcare experience

Potential pay for this position ranges from $ – $ based on experience and skills.

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.