Prime Healthcare · 2 weeks ago
Vice President of Health Plan Operations and Claims
Ontario, CA
Full-time
Onsite
Director/Executive
$150K/yr - $250K/yr
7+ years expPrime Healthcare is an award-winning health system headquartered in Ontario, California. The Vice President of Health Plan Operations and Claims is responsible for developing and executing Claim Operations strategies, optimizing the claims process, and collaborating with various departments to ensure data integrity and drive financial value across Employee Health Plans.
Health CareHospital
Responsibilities
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
Qualification
Required
Master's Degree in Business Management, Healthcare Administration, or other relevant fields
A minimum of seven (7) to ten (10) years prior work experience in Claims Operations and Health Plan Strategy, in a Managed Care, Self-Funded or hospital setting is required
Analytical skills with emphasis on generation and utilization of data to drive operational and financial performance
Ability to work in a complex, rapidly evolving environment with multiple internal and external entities and boundaries
Strong interpersonal skills, problem solving and project/time management essential
Ability to develop presentations to all levels using Microsoft Office applications
Strong knowledge of medical coding (ICD-10, HCPCs/CPT, etc.)
Preferred
Certified Professional Coding Certification, AIC, ARM, or equivalent
Familiarity with multiple Business Intelligence software systems and daily usage of at least one
Benefits
Paid time off
A 401K retirement plan
Medical, dental, and vision coverage
Tuition reimbursement
Many more voluntary benefit options
Company
Prime Healthcare
About Prime Healthcare and Prime Healthcare Foundation: Prime Healthcare is an award-winning health system operating 51 hospitals and more than 360 outpatient locations in 14 states, providing over 2.5 million patient visits annually.
10001+ employees
H1B Sponsorship
Prime Healthcare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (7)
2023 (4)
2022 (5)
2021 (9)
2020 (6)
Funding
Current Stage
Late StageTotal Funding
$1.5B2024-09-04Debt Financing· $1.5B
Leadership Team
Luis Leon
Chief Operating Officer, Chief Executive Officer Region VI
Recent News
2025-11-19
Morningstar.com
2025-11-15
Company data provided by crunchbase