[Hiring] Vice President, Claims and Provider Operations @SCAN Health Insurance

Role Description

The Vice President, Claims and Provider Operations leads the strategy, performance, and modernization of claims, configuration, provider data, payment integrity, and capitation operations. This role is accountable for building a high-performing, compliant, and scalable operating model that improves accuracy, timeliness, affordability, provider experience, and member outcomes.

The Vice President drives operational excellence through strong controls, payment integrity, configuration discipline, AI, automation, analytics, process redesign, and optimization of internal, vendor, and partner-enabled delivery capabilities.

• Leads a multi-disciplinary organization across claims intake, adjudication, configuration, provider data operations, payment integrity, capitation, and operational support.
• Owns end-to-end operational accuracy, timeliness, compliance, and control performance across claims and provider operations.
• Leads the evolution and transformation of claims and provider operations through workflow simplification and automation.
• Partners closely with IT, EDI Operations, Finance, Network Management, Compliance, Clinical, Appeals and Grievances, and other business leaders.
• Drives affordability through payment integrity, configuration discipline, and disciplined claims controls.
• Owns payment integrity savings targets, vendor and recovery contractor performance, and regular reporting of operational and financial results.
• Ensures strong regulatory compliance, audit readiness, policy adherence, risk management, and data governance.
• Builds, develops, and retains a high-performing team of directors, managers, supervisors, analysts, examiners, and subject matter experts.
• Sets and owns the multi-year claims and payment integrity roadmap.
• Develops and manages the annual operating budget for claims and payment integrity functions.
• Actively supports the achievement of SCAN’s Vision and Goals.

Qualifications

• Bachelor’s Degree or equivalent experience, MBA Preferred.
• 10-15+ years of progressively responsible healthcare operations leadership experience.
• Demonstrated experience leading large teams and complex transformation initiatives.
• Strong knowledge of claims processing, claim editing, system configuration, and payment integrity.
• Demonstrated accountability for provider data management accuracy.
• Exceptional analytical, financial management, and executive communication skills.

Requirements

• Experience in Medicare Advantage or related healthcare environment.
• Ability to drive operational excellence through strong controls and analytics.
• Proven track record in managing budgets and financial performance.

Benefits

• Base Pay Range: $260,000-$325,000, Salary + Incentive Plan.
• Work Mode: Remote.
• An annual employee bonus program.
• Robust Wellness Program.
• Generous paid-time-off (PTO).
• 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days.
• Excellent 401(k) Retirement Saving Plan with employer match.
• Robust employee recognition program.
• Tuition reimbursement.
• An opportunity to make a difference to our members and our community.