Senior Vice President, Claims Services and Solutions

ImagenetLLC•Tampa, FL

About The Position

Imagenet is seeking an exceptional executive to lead and transform our healthcare payer Claims Services organization. As a trusted partner to more than 70 health plans nationwide, Imagenet delivers technology-enabled claims administration, business process outsourcing (BPO), digital transformation, document management, and contact center solutions that help clients improve operational performance while enhancing the member and provider experience. Reporting to the Chief Client Officer / EVP, Claims & Call Center Solutions and Services, the SVP, Claims Services & Solutions will be responsible for the overall leadership, performance, and future evolution of Imagenet’s healthcare payer Claims Services business. This is not a traditional Claims Operations leadership role. This executive will lead one of Imagenet’s core service offerings while partnering closely with Sales, Client Services, Technology, Product, and Executive Leadership to shape the future of our healthcare payer Claims business. The role combines operational leadership, client engagement, strategic solutioning, and business growth—offering the opportunity to make a lasting impact on both our clients and our organization.

Requirements

15+ years of progressive healthcare payer claims experience, including claims processing, adjudication, complex claims, quality, productivity, service levels, and operational performance management.
10+ years leading claims operations, claims services, claims delivery, or claims transformation in a healthcare payer BPO, outsourcing, managed services, BPaaS, payer administrative services, or similar client-services environment.
Demonstrated success improving quality, reducing backlog and aging, increasing productivity, stabilizing operations, and rebuilding client confidence.
End-to-end claims process ownership, including intake, assignment, workflow, pends, QA, release governance, reporting, escalation, and final disposition.
Executive-level client relationship experience, including governance meetings, QBRs, steering committees, executive escalations, renewal support, and recovery conversations.
Experience supporting growth through RFPs, solution design, staffing models, pricing, SOWs, finalist presentations, and client expansion.
Strong financial and operational management experience, including staffing economics, cost of quality, labor utilization, margin management, and investment tradeoffs.
Ability to translate claims operating needs into practical technology, analytics, workflow, automation, and quality-control requirements.
California Healthcare Payer Experience Required: Meaningful California healthcare payer market experience is a core requirement for this role. Qualified candidates should have practical experience supporting California-based health plans, Medi-Cal programs, California managed care organizations, Claims Administration services, delegated services models, payer administrative services, or comparable California payer environments.

Responsibilities

Build and scale a high-performing, multi-client claims operating model from claim receipt through final disposition.
Drive operational excellence across quality, turnaround time, productivity, pends, inventory, backlog, workforce readiness, and client service-level commitments.
Lead operational turnaround and stabilization initiatives in complex or underperforming claims environments.
Strengthen proactive quality assurance, audit discipline, root-cause resolution, coaching, release controls, and measurable error reduction.
Establish disciplined claims rule governance, operational knowledge management, version-controlled client instructions, and single-source-of-truth practices.
Partner with Technology and Product teams to define business requirements for workflow, routing, dashboards, audit tracking, knowledge access, release controls, automation, and AI-enabled quality processes.
Lead executive client engagement, including QBRs, governance meetings, escalations, renewal support, recovery discussions, and operational reviews.
Partner with Sales, Account Management, and Client Services on discovery, RFPs/RFIs, staffing models, pricing assumptions, SOWs, finalist presentations, and expansion opportunities.
Own financial and operating performance, including budgets, labor utilization, productivity economics, cost of quality, margin improvement, and investment recommendations.
Build, coach, and develop a strong claims leadership organization capable of supporting growth and consistently delivering on client commitments.