Senior Vice President

Senior Vice President of Engineering and Technology - Healthcare Payer Domain Key Responsibilities: Strategic Leadership: Lead the development and execution of technology-driven strategies for payer operations, focusing on automation, AI, and data analytics to optimize claims processing, member engagement, and cost containment. Stay updated on industry trends, regulatory changes (CMS, ACA), and emerging technologies to adapt payer strategies. Operational Excellence: Oversee technology platforms supporting payer operations, ensuring accurate claims processing and reimbursement. Drive automation and efficiency initiatives to reduce operational costs and improve service delivery. Technology & Data Integration: Collaborate with IT teams to implement advanced systems for claims adjudication, payment integrity, and member engagement. Utilize data analytics and AI to enhance risk management, improve care outcomes, and support value-based payment models. Ensure compliance with healthcare standards (EDI, HIPAA, FHIR). Leadership & Team Building: Build and lead cross-functional teams in payer operations, technology, and analytics to drive innovation and continuous improvement. Foster a collaborative culture and provide mentorship to team members. Stakeholder Management: Strengthen relationships with providers, regulators, and other stakeholders through technology-driven service improvements. Represent the organization in tech-focused forums and regulatory discussions. Financial Management: Oversee technology budgets to ensure cost-effectiveness and ROI. Leverage technology to reduce medical loss ratios (MLR) and optimize revenue streams. Qualifications: Bachelor's degree in Healthcare IT, Business, or related field; advanced degree preferred. 25+ years of experience in healthcare payer roles, with a strong focus on technology solutions like claims systems and analytics platforms. In-depth knowledge of payer regulations (CMS, HIPAA, ACA) and technology standards. Strong leadership, strategic thinking, and problem-solving skills.