Vice President of Health Plan Operations and Claims
Listed on 2026-01-27
-
Healthcare
Healthcare Management, Healthcare Administration
Job Details
- Facility:
Prime Healthcare Management Inc - Location:
US-CA-Ontario - Job :
- Category:
Executive - Position Type:
Full Time - Shift: Days
- Job Type: Exempt
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation's leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity.
Prime Healthcare is actively seeking new members to join our corporate team!
This position requires relocating to Ontario, California.
The Vice President of Health Plan Operations and Claims 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 Operations and Claims 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 Operations and Claims 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.
We’re looking for someone with operations experience with self-funded health plans including designing operational improvements, performance management techniques and metrics. Someone with significant claims experience including PDR’s, Disputes, Appeals and Recoveries. Sound intriguing, then you will be thrilled to know we offer very competitive compensation and amazing benefits.
As you would expect, this role has many facets including Health Plan Operations, Health Performance Metrics, Cost Reduction, Market Forces, Quality and Delivery of Care, Regulatory Reforms, Strategy and Operating Models, Long Term Business Objectives, Healthcare Payers, Claim Operations Strategies, Claim Process Automation, Self-Funded Plans, and Employee Health Plans.
QualificationsRequired qualifications:
Preferred qualifications:
Prime Healthcare Management, Inc. offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more…
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