AVP, Out of Network Operations (Remote)

Claritev•New York, NY

8d•$160,000 - $175,000•Remote

About The Position

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.

Requirements

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.

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.

Benefits

health insurance
401(k)
bonus opportunity
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.