[Hiring] Manager, Claims Vendor Management @Pie Insurance

Role Description

The Manager, Claims Vendor Management leads Pie's Claims Vendor Management program for assigned strategic claims vendors, focusing on oversight of managed care program vendors. This role manages Claims vendor relationships including:

• Managed care services (medical bill review, pharmacy benefit management, utilization review, provider networks)
• Legal vendors (law firms and litigation support)
• Investigative services
• Support vendors (transportation, translation)
• API-integrated technology vendors

The Manager executes vendor strategy in partnership with Claims leadership, including:

• Supporting a sunset program to eliminate redundant contracts
• Running a formal RFP process for competitive vendor selection
• Leading contract negotiations and renegotiations to optimize value and performance

This role requires strong relationship management skills, solid analytical capabilities to identify cost reduction opportunities, and the ability to collaborate across Claims, Legal, Finance, and Procurement.

Qualifications

• Bachelor's degree in Business Administration, Finance, Supply Chain Management, or related field
• 6+ years of experience in vendor management, procurement, or strategic sourcing
• 3+ years of experience in the insurance industry, preferably in claims operations or vendor management
• 1+ years of experience leading or mentoring team members; direct people management experience a plus
• Track record of leading vendor contract negotiations and achieving cost savings
• Experience supporting or implementing vendor management programs
• Strong understanding of workers' compensation and managed care vendors landscape
• Working knowledge of managed care services including medical bill review, pharmacy benefit management, utilization review, and provider networks
• Knowledge of legal vendor management including law firm relationships and litigation support services
• Understanding of investigative services, transportation, translation, and other ancillary claims support vendors
• Exposure to API-integrated technology vendors and understanding of system integration requirements

Requirements

• Support implementation of Pie's Claims Vendor Management program for assigned strategic claims vendors
• Execute vendor management strategy for the Claims Department in partnership with Claims leadership
• Support and help develop vendor management team members contributing to strategic initiatives
• Create and maintain a centralized repository of all vendor contracts with visibility across departments
• Implement vendor performance management frameworks and accountability structures
• Support policies, procedures, and work plans that affect the team and contribute to department-wide initiatives
• Provide oversight of managed care program vendors
• Ensure managed care vendors deliver quality services that support medical cost containment objectives
• Monitor compliance with contractual obligations and service level agreements for managed care vendor relationships
• Collaborate with Senior Director, Managed Care Services on vendor strategy and performance
• Assess vendor performance impact on medical loss costs and claim outcomes
• Support initiatives to optimize managed care vendor portfolios and drive cost savings
• Manage day-to-day vendor relationships across various vendor categories
• Apply vendor management strategies tailored to the unique requirements of each vendor category
• Ensure consistent application of vendor management standards across diverse vendor categories
• Coordinate vendor relationships to support seamless Claims operations and optimal outcomes
• Support a sunset program to identify and eliminate redundant or underperforming vendor contracts
• Run a formal RFP process to ensure competitive and transparent vendor selection
• Lead contract negotiations, renewals, and renegotiations to drive cost savings and improved terms
• Support sourcing strategies in collaboration with Claims leadership to achieve cost reductions
• Analyze internal vendor costs against market forces to reduce Pie's claim costs
• Facilitate quarterly or annual meetings with Claims and vendor stakeholders to discuss performance
• Collect and collate vendor performance feedback and review vendor spend and billing practices
• Establish KPIs to monitor vendor performance and support accountability and continuous improvement
• Perform vendor billing audits and support vendor spend reviews
• Support the transition of vendors to improved billing and bulk billing practices
• Implement agreed plans with Claims leadership to optimize billing processes
• Ensure compliance with billing practices and enterprise standards
• Partner with Claims leadership, Legal, Finance, and Procurement to ensure alignment and compliance
• Collaborate with cross-functional teams to support product launches and operational needs

Benefits

• Competitive cash compensation
• Comprehensive health plans
• Generous PTO
• Future focused 401k match
• Generous parental and caregiver leave