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Added 10 mins ago
LV
Radio Systems Specialist
Las Vegas Metropolitan Police Department
Las Vegas, NV
- $32.37 to $47.91 USD / hour
Participate in the LVMPD Mental Wellness Program.
Added 17 mins ago
J
DOT Compliance Coordinator
Jobgether
Remote, United States
- $25 to $30 USD / hour
…Administration (FMCSA) driver qualification and compliance program, ensuring that driver records are accurate, complete, and up to date. You will coordinate documentation and qualification…
Added 18 mins ago
M
Retail Sales Associate, Stanford Shopping Center - Part Time
Macy's
Palo Alto, CA
- Part-time
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
Seasonal Retail Commission Sales Associate - Fine Jewelry, Old Orchard
Macy's
Skokie, IL
1-2 years of related experience required
Added 18 mins ago
Seasonal Fulfillment and Receiving Support Associate, Mall in Columbia
Macy's
Columbia, MD
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
M
Retail Fulfillment and Receiving Support Associate, Mall In Columbia - Part Time
Macy's
Columbia, MD
- Part-time
Employee Assistance Program with mental health counseling and legal/financial advice
Added 18 mins ago
M
Retail Sales Associate, Stonebriar Centre - Part Time
Macy's
Frisco, TX
- Part-time
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
Seasonal Retail At Your Service Associate, Coral Square
Macy's
Coral Springs, FL
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
Seasonal Retail Commission Sales Associate - Fine Jewelry, West Covina
Macy's
West Covina, CA
1-2 years of related experience required
Added 18 mins ago
M
Retail Fulfillment and Receiving Support Associate, Woodland - Full Time
Macy's
Kentwood, MI
- Full-time
Employee Assistance Program with mental health counseling and legal/financial advice
Added 18 mins ago
M
Retail Sales Associate - Womens Shoes, Walden Galleria - Full Time
Macy's
Cheektowaga, NY
- Full-time
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
Seasonal Retail At Your Service Associate, Stanford Shopping Center
Macy's
Palo Alto, CA
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
M
At Your Service Center Associate, Santa Maria Town Center - Full Time
Macy's
Santa Maria, CA
- Full-time
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
Seasonal Retail Commission Sales Associate - Fine Jewelry, Fairlane Town Center
Macy's
Dearborn, MI
1-2 years of related experience required
Added 18 mins ago
Seasonal Retail Commission Sales Associate - Fine Jewelry, Arrowhead Towne Center
Macy's
Glendale, AZ
1-2 years of related experience required
Added 18 mins ago
M
At Your Service Center Associate, Montebello Town Center - Full Time
Macy's
Montebello, CA
- Full-time
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
Seasonal Fulfillment and Receiving Support Associate, Waikiki
Macy's
Honolulu, HI
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
M
Retail Sales Associate, Reno Meadowood - Full Time
Macy's
Reno, NV
- Full-time
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
M
Retail Sales Associate - Womens Shoes, Dartmouth - Part Time
Macy's
Dartmouth, MA
- Part-time
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
Seasonal Retail Sales Associate, Chula Vista Center
Macy's
Chula Vista, CA
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you, often walking the package around and using…
Added 18 mins ago
Seasonal Retail Support Associate - Shoe Expeditor, Colonie Center
Macy's
Albany, NY
They always Finish Strong - sharing our Loyalty program benefits, making sure customers have all they need, and ending with a sincere thank-you. They collaborate with the team to tie up…
Added 18 mins ago
M
Retail Fragrances Sales Support Associate - Dior, Downey Stonewood Center - Full Time
Macy's
Downey, CA
- Full-time
Employee Assistance Program with mental health counseling and legal/financial advice
Added 18 mins ago
M
Retail Fragrances Sales Support Associate - Prada/YSL, Arden Fair - Full Time
Macy's
Sacramento, CA
- Full-time
Employee Assistance Program with mental health counseling and legal/financial advice
Added 20 mins ago
Cyber Threat Analyst
Leidos
Pearl Harbor, HI
· Bachelor’s degree with 4+ years of relevant experience; OR an Associate degree with 6+ years; OR 8+ years of relevant experience / military service in lieu of a degree.
Added 21 mins ago
Automotive Maintenance Technician
Bridgestone Americas
Kailua, HI
Must have a valid automobile driver's license at all times and be able to drive customer and company vehicles

Prime Therapeutics

AVP Claims & Configuration - REMOTE

Jefferson City, MO, United States

Potential pay for this position ranges from $164,000.00 - $279,000.00 based on experience and skills.

Apply on hiremo.mo.gov About employer

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Job details

Pay: Potential pay for this position ranges from $164,000.00 - $279,000.00 based on experience and skills.
Posting language: English

Original job description

Summary

Home

Full time

R-17204

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 Title

AVP Claims & Configuration - REMOTE

Job Description

The Associate Vice President, Claims & Configuration is responsible for the strategic leadership, operational performance, and continuous evolution of pharmacy benefit claims adjudication, benefit configuration capabilities, and network operations. This role ensures accurate, compliant, and scalable administration of pharmacy benefit programs while driving technology modernization, operational efficiency, and client satisfaction.

Responsibilities

+ Lead cross-functional teams responsible for claims adjudication, benefit configuration, testing, and production support

+ Drive modernization and continuous improvement initiatives that enhance operational efficiency, scalability, accuracy, data-driven decision making and customer experience

+ Own execution of the strategy, roadmap, and governance for pharmacy claims adjudication and benefit configuration capabilities, ensuring alignment with business, client, and regulatory requirements

+ Oversee the accurate interpretation and implementation of client benefit plans, formularies, accumulators, pricing, utilization management rules, and clinical programs within claims processing systems

+ Collaborate with key internal partners and business leaders to prioritize enhancements, drive operational transformation to support technology changes, and deliver strategic business outcomes

+ Establish and monitor key performance, quality, compliance, and financial metrics to ensure claims adjudication accuracy, configuration integrity, service excellence, and regulatory compliance

+ Lead operational initiatives to simplify processes, reduce operational risk, improve speed-to-market, and address technical debt across claims and configuration ecosystems

+ Develop organizational capability through talent management, succession planning, budget oversight, and leadership of high-performing teams focused on operational excellence

+ Other duties as assigned

Minimum Qualifications

+ Bachelor's degree in Business, Health Care Administration, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED required

+ 12 years of work experience in PBM, health plan, or healthcare operations, including experience with large scale platform enabled transformations

+ 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 distill complex concepts or situations into concise and compelling communications

+ Advanced problem-solving skills, including the ability to assess operational, financial, compliance, and client impacts of business decisions

+ Executive presence with exceptional communication, influencing, and stakeholder management skills across operations, technology, clinical, product, and client-facing teams

+ Strong understanding of regulatory and industry requirements impacting pharmacy benefit administration and claims processing

+ Expertise in operational excellence, quality management, risk mitigation, and governance practices within highly regulated environments

+ Ability to lead and develop high-performing teams through coaching, succession planning, organizational design, and talent development

Preferred Qualifications

+ PBM experience, including claims adjudication, benefit configuration, formulary management, pricing, accumulators, and clinical program administration

+ Experience with pharmacy claims adjudication platforms, benefit configuration systems, and implementation of complex client benefit plans

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

Potential pay for this position ranges from $164,000.00 - $279,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/benefits) 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.

At Prime Therapeutics (Prime), we are a different kind of PBM. We're reimagining pharmacy solutions to provide the care we would want for our loved ones. That purpose energizes our team and creates limitless opportunities to make a difference.

We know that people make all the difference. If you're ready for a purpose-driven career and are passionate about simplifying health care, let's build the future of pharmacy together.

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.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at email Careers@primetherapeutics.com.

Apply on hiremo.mo.gov About employer

More about this job

Skills

Leadership
Process improvement
Decision making
Customer experience
Claims processing
Regulatory compliance
Team leadership
Problem solving
Communication skills
Stakeholder management
Quality assurance procedures
Coaching

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Work requirements

Jobs in the United States