Assistant Vice President, Medical Claims Operations

Location: Home United States; fully remote

Company

Specialist professional services and technology firm supporting insurance, financial services, public sector, and other highly regulated organizations with risk, claims, operations, and transformation solutions.

What you will do

• Lead claims staff, including Claims Directors, Claims Examiners, and Claims Assistants, through coaching, performance management, workload planning, and development.
• Oversee client accounts and act as a senior contact for clients, intermediaries, and internal stakeholders.
• Review complex medical excess, provider excess, HMO reinsurance, and employer stop loss claims and related reinsurance matters.
• Interpret policies, reinsurance agreements, plan descriptions, provider contracts, and claim data to determine coverage and reimbursement.
• Monitor quality standards, reporting, invoices, payment integrity reviews, and operational risks.
• Improve claims procedures, controls, reporting practices, and workflow efficiency while supporting audits, projects, and client meetings.

Requirements

• 10+ years of progressively responsible experience in medical claims management, managed care claims operations, health plan administration, payment integrity, provider risk management, employer stop loss, or medical excess claims.
• Leadership experience managing claims professionals, workflows, quality standards, and client deliverables.
• Strong knowledge of self-insured plans, managed care, risk-sharing arrangements, medical and pharmacy claims, claim processing platforms, and supporting contracts.
• Working knowledge of CMS regulations, Medicare and Medicaid programs, fee schedules, medical terminology, and coding.
• Strong leadership, client service, communication, analytical, problem-solving, and organizational skills.
• Proficiency in Microsoft Word and Excel and the ability to manage multiple priorities independently.

Culture & Benefits

• Fully remote work arrangement based in the United States.
• Permanent, full-time employment.
• Work with a global professional team operating across ten countries.
• Occasional travel for audits, projects, or client meetings.
• Opportunities to contribute to innovation, automation, colleague development, and client service.

Hiring process

• Application and CV review.
• Interview followed by a second-stage interview.
• Offer and hiring.