Associate Vice President, Claims Operations Greater Pittsburgh, PA Area

The Company is in search of an Associate Vice President (AVP) for Claims Operations, a key executive role responsible for the strategic and operational performance of the health plan's claims administration function. The successful candidate will lead a large, complex claims organization with a focus on driving efficiency, accuracy, automation, and cost-effectiveness while upholding the highest standards of compliance, quality, and service. This includes executive oversight of end-to-end claims processing operations, from adjudication to regulatory compliance, and a commitment to balancing financial stewardship, provider satisfaction, member experience, and organizational performance objectives. The AVP will also be instrumental in operational transformation, workforce development, and the implementation of enterprise claims strategies to support growth and long-term success. Applicants for the AVP position should have a Bachelor's degree in a related field, with a preference for a degree in healthcare administration, business administration, finance, or public health. A minimum of 5 years' progressive healthcare payer or managed care operations experience, along with 10 years' of leadership experience, is required. The ideal candidate will have a proven track record in leading claims operations within a health insurance, managed care, Medicare, Medicaid, or commercial health plan environment, and experience in large-scale operational transformation initiatives. Proficiency in presenting operational performance and strategic recommendations to executive leadership, as well as experience with AI tools in claims adjudication, is essential. The role also demands a background in Medicare Advantage, Medicaid Managed Care, Commercial, and ACA Marketplace, and experience with enterprise claims administration platforms, workflow management systems, and operational best practices.

Hiring Company

UPMC