AVP, Out of Network Operations (Remote)
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and upward!
Job Summary
This position leads, plans, develops, and directs aspects of respective cost centers, functions, and/or processes within the Referenced Based Pricing (RBP) department. The AVP is accountable for managing revenue-generating operations within the company, partnering on the technical/product roadmap, and driving strategic initiatives that require exceptional leadership and external-facing collaboration. This role demands strong operational expertise, deep healthcare knowledge, and the ability to navigate complex regulatory environments.
- Job Roles and 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.
Job Requirements (Education, Experience, and Training)
- 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.
Salary & Benefits
Salary range: $160–175K, plus health insurance, 401(k), bonus opportunity, and comprehensive benefits package.
COMPENSATION
The salary range for this position is $160-175,000. Specific offers consider a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k, and bonus opportunity.
REQUIREMENTS
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BENEFITS
We realize that our employees are instrumental in our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
- 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
- WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional 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.
EEO STATEMENT
Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.
APPLICATION DEADLINE
We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.
#LI – VG1
What We Do
Claritev is an independent and public healthcare technology, data and insights company making healthcare more transparent, fair and affordable for all. We work across the healthcare value chain to expose imbalanced and inefficient pricing practices. Led by deeply experienced analysts, negotiators and innovators, Claritev provides tech-enabled solutions and services fueled by proprietary data from over 40 years of experience. Today, along with machine learning and AI, we utilize a robust enterprise platform to deliver price transparency, improve payment accuracy, and drive more meaningful analytics and decision-making.
Through Claritev, providers are able to make data-enabled decisions to optimize their service offerings, market position and ultimately deliver high-quality care. Payors and third-party administrators can deliver greater flexibility and value to plan sponsors. Employers can drive cost-efficient benefit design and patients can finally afford the care they need.
By focusing on customized solutions that that improve transparency, affordability and quality for all key players, we’re igniting a more competitive marketplace — one that lowers overall costs while improving quality. Claritev brings the transparency our nation needs to see its way to a better healthcare system.
