At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Job Posting TitleAVP Claims Block Owner - RemoteJob DescriptionThe AVP Claims Block Owner is responsible for defining and driving the enterprise vision and multi-year strategy for the claims block, ensuring alignment across key stakeholders. This role partners cross-functionally to identify improvement opportunities, set realistic delivery expectations, and lead large-scale initiatives that enhance claims capabilities, technology, and operational efficiency. This position oversees development and management of the business value case to support strategic investment in the roadmap.
Responsibilities
- Define and lead the multi-year claims technology and capability strategy, including roadmap development for claims platforms, capacity planning, prioritization of enhancements, and assessment and sunsetting of claims-adjacent systems to reduce complexity and improve efficiency in partnership with key stakeholders
- Lead and communicate the enterprise vision for claims block, ensuring alignment to roadmap across business units and active engagement with peer block owners to identify gaps, challenge existing processes, and drive continuous improvement across claims capabilities
- Establish clear delivery boundaries and expectations in partnership with account management, aligning on client commitments and operational feasibility
- Drive education, communication, and adoption strategies across business units and functional teams, including the development of business case vision and value for investment
- Partner with Claims Operations, Configuration Operations, and Strategic Solutions teams to lead large-scale, high-impact initiatives that improve claims outcomes and business performance
- Assess and manage external partner impacts and dependencies, ensuring alignment with organizational capabilities, contractual obligations, and long-term strategic goals
- Remain aware of leading-practice industry technologies, including AI, and ensure future-state roadmaps responsibly include leading-edge technological capabilities
- Other duties as assigned
Minimum Qualifications
- Bachelor's degree in Business, Healthcare Administration or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or GED is required
- 12 years of work experience in project management, portfolio management or operations
- 8 years of leadership/people management experience
Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
- Demonstrated ability to communicate effectively, both verbal and written, and the proven ability to work effectively with all organizational levels and external contacts
- Strong strategic-thinking, analytic, and problem-solving skills
- Excellent facilitation, presentation, and consultative skills; skilled at managing meetings and listening with the ability to interpret information into consistent and concise actions that drive results
- Ability to effectively drive business and lead transformation in a dynamic and complex operating environment
- Strong conflict management skills with ability to influence and drive stakeholders to most impactful outcomes
- Understanding of adjudication engines and technical risk management
Preferred Qualifications
- Master of Business Administration
- Pharmacy Benefit Management or healthcare experience
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.
Skills Required
- Bachelor's degree in Business, Healthcare Administration or related area, or equivalent combination of education and/or relevant work experience
- High school diploma from an accredited school or GED
- 12 years of work experience in project management, portfolio management or operations
- 8 years of leadership/people management experience
- Must be eligible to work in the United States without the need for work visa or residency sponsorship
- Demonstrated ability to communicate effectively, both verbal and written, and work with all organizational levels and external contacts
- Strong strategic-thinking, analytic, and problem-solving skills
- Excellent facilitation, presentation, and consultative skills; skilled at managing meetings and translating information into actions
- Ability to effectively drive business and lead transformation in a dynamic and complex operating environment
- Strong conflict management skills with ability to influence stakeholders to impactful outcomes
- Understanding of adjudication engines and technical risk management
- Master of Business Administration (MBA)
- Pharmacy Benefit Management or healthcare experience
Prime Therapeutics Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Prime Therapeutics and has not been reviewed or approved by Prime Therapeutics.
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Healthcare Strength — Health coverage is described as comprehensive, with medical, dental, and vision options and plan designs that include low deductibles for some choices. Wellness screenings and related incentives add perceived value to the health offering.
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Retirement Support — Retirement benefits stand out through a 401(k) match that is characterized as generous and immediately vested. This structure improves the overall long-term value of the total rewards package.
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Strong & Reliable Incentives — Annual incentive bonuses are positioned as a meaningful component of total compensation and are often portrayed as substantial when performance goals are met. Incentive eligibility appears broadly available across roles, boosting the perceived completeness of rewards.
Prime Therapeutics Insights
What We Do
Everything we do is connected to helping people get the medicine they need to feel better and live well. It’s meaningful work and we’ve been doing it for over 20 years. In the pharmacy benefit management (PBM)industry, we’re different. We’re owned by 18 not-for-profit Blue Cross and Blue Shield health plans. This allows us to control costs and empower our employees to put members first. It’s a successful combination. We have the lowest pharmacy trend in the industry and serve 28+ million members throughout the US. In addition to core PBM services, we work closely with our clients to implement the right benefit design, clinical and specialty programs, formulary and networks. A few key products: • NetResults™ • Specialty Drug Management • Best in Care™ • GuidedHealth® • Advanced Fraud, Waste and Abuse: Member and Prescriber Investigations • Prime Analytics™ • CareCentered Contracting™Controlled Substance Management Program Join us! Prime is always looking for smart, purposeful people to join our team. We’re growing fast which means there are plenty of opportunities to advance and grow in your career. At the same time, Prime supports flexibility and offers generous PTO so you can enjoy an enviable work/life balance. We’re a privately held company -big enough to make a difference and small enough for you to have an impact. Follow Prime on LinkedIn to learn more.
