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Claritev · 17 hours ago

AVP, Out of Network Operations (Remote)

United States

Full-time

Remote

Director/Executive

$160K/yr - $175K/yr

10+ years exp

Claritev is a dynamic team of innovative professionals striving to bend the cost curve in healthcare. The AVP, Out of Network Operations will lead and direct operations within the Referenced Based Pricing department, managing revenue-generating operations and driving strategic initiatives while ensuring compliance with regulatory environments.

BillingHealth CarePayments

Responsibilities

Direct the daily operations of assigned business units to ensure consistent delivery of quality results, operational efficiency, and attainment of expectations set forth by internal and external clients

Own revenue performance for assigned business lines, ensuring delivery on annual budget targets and multi‑year growth commitments

Develop growth strategies (organic growth, service expansion, cross‑functional initiatives) with key partners in product, service, sales, regulatory/legal and technology

Drive operational excellence across high-revenue business units, ensuring strategic alignment with organizational goals

Provide leadership through real-time management and mid- & long-range forecasting, supporting succession planning and business strategy

Manage execution of the RBP (DiS) Services objectives through team members in a timely, cost-effective manner

Develop and maintain strong relationships both internally and externally, including but not limited to open communication amongst all departments within the organization to ensure company and department goals are consistently met

Establish, monitor and improve KPIs for cycle time, productivity, cost‑to‑serve, utilization, customer experience, and quality

Oversee execution and completion of complex service and claims issues, resolving them timely, effectively and with minimal supervision

Translate business needs into technical and service requirements, including workflow automation, platform enhancements, new features, or integrations while assisting with digital transformation strategy

Champion user adoption through change management, training, and communication plans

Partner with product and technology teams to influence and align on the technical roadmap for enhanced product delivery and operational improvements and innovation

Demonstrate strong appeal and negotiation skills when managing internal or external escalations and complex service issues

Collaborate closely with support and service teams to ensure seamless execution of operational and client objectives in delivering high-quality, scalable and efficient solutions

Lead large-scale healthcare operations with strong oversight of regulatory and legal compliance

Serve as an external-facing leader, representing the organization in client meetings, regulatory discussions, and strategic partnerships

Regularly communicate with organizational leadership on performance, risks, opportunities, and program updates

Maintain awareness of regulatory changes and proactively update operations and roadmaps as needed

Direct the budget process and financial planning for assigned cost center(s), balancing cost containment with department needs and customer satisfaction

Serve as a business sponsor for Agile application development projects and other associated client implementation initiatives

Select, develop, and evaluate staff to ensure efficient operation of the department, fostering engagement and performance across teams of 50-100+

Ensure compliance with HIPAA regulations and requirements

Demonstrate Company’s Core Competencies and values

Other duties as assigned

Qualification

Healthcare operations expertiseOperational managementRegulatory compliance knowledgeTechnical roadmap partnershipClient escalation managementLeadership experienceAnalytical skillsNegotiation skillsCommunication skillsOrganizational skills

Required

Minimum bachelor's degree in a relevant field coupled with 10 years' experience in an operational management/leadership role, at least 7 years of which should include healthcare markets (insurance companies, TPA, HMO, or managed care)

Proven track record of managing high revenue streams within an organization

Strong leadership experience in building and scaling teams of 50-100+ members

Extensive experience handling client escalations and navigating litigation issues within healthcare operations

Deep understanding of regulatory and legal frameworks impacting large healthcare organizations

Proven experience partnering on technical roadmaps and driving technology-enabled operational strategies

Strong appeal and negotiation skills for resolving escalations and influencing outcomes

Demonstrated ability to collaborate effectively with internal support teams and external stakeholders

External-facing experience with clients, regulators, and legal entities in large-scale healthcare operations

Knowledge of health care and managed care products

Excellent communication, leadership, planning, analytical, and organizational skills

Ability to travel as needed

Benefits

Health insurance

401(k)

Bonus opportunity

Medical, dental and vision coverage with low deductible & copay

Life insurance

Short and long-term disability

Paid Parental Leave

401(k) + match

Employee Stock Purchase Plan

Generous Paid Time Off - accrued based on years of service

10 paid company holidays

Tuition reimbursement

Flexible Spending Account

Employee Assistance Program

Sick time benefits - for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits.

Company

Claritev

Glassdoor3.8

Claritev is an independent and public healthcare technology, data and insights company making healthcare more transparent, fair and affordable for all.

Founded in 1980

Mclean, Virginia, USA

1001-5000 employees