Staff VP Digital Claims Operations

Elevance Health•Indianapolis, IN

9d•Hybrid

About The Position

The Staff Vice President, Digital Claims Operations drives the digital transformation of claims processes within Health Benefits Operations. Reporting to the Vice President, Claims Operations, this leader integrates strategic planning, process optimization, analytics, and technology implementation to improve operational efficiency, processing accuracy, and service quality across claims management. The role develops and executes a digital claims strategy aligned with company objectives and leads transformation initiatives involving AI, automation, advanced analytics, and end-to-end solution delivery. As the claims analytics domain lead, the executive supports enterprise actuarial reserving and Cost of Care initiatives while connecting operations, analytics, and technology through deep claims expertise. The successful executive combines enterprise perspective, disciplined execution, innovation, and stakeholder leadership. They build and develop a collaborative, high-performance team, establish accountability, and foster trust, inclusion, continuous learning, and measurable outcomes. The role oversees digital claims operations, pilots and transformation programs, budgets, resources, risk, compliance, and delivery readiness. The position is hybrid and requires associates to be in-office three days per week. It may be based at an Elevance Health PulsePoint office, with specified preferred locations and alternate locations considered for candidates within commuting distance.

Requirements

Bachelor of Arts or Bachelor of Science degree in Information Technology, Computer Science, or a related field.
A minimum of 15 years of claims operations management and digital transformation experience.
Proven leadership and team management skills.
Strong analytical and communication abilities.
In-depth understanding of industry regulations and compliance standards.

Nice To Haves

Advanced degree in business, technology, analytics, healthcare administration, or a related field.
Demonstrated experience leading AI, automation, analytics, process optimization, and technology-enabled change in a complex, matrixed organization.
Experience managing budgets, cross-functional portfolios, major implementations, and end-to-end solution delivery.
Executive-level experience leading digital claims operations within a large healthcare enterprise.
Experience supporting actuarial reserving, Cost of Care, payment integrity, or related financial and analytical priorities.
Experience scaling AI and automation from pilot through production with strong governance, adoption, and benefit-realization disciplines.
Demonstrated success integrating claims operations, analytics, technology, product, provider data management and configuration, and change management into a cohesive operating model.

Responsibilities

Develop, communicate, and execute the digital claims strategy and transformation roadmap.
Translate company objectives and claims priorities into sequenced initiatives, investment choices, operating changes, and measurable outcomes.
Lead transformation initiatives involving AI, automation, analytics, workflow redesign, and digital capabilities.
Identify opportunities to simplify claims processes, reduce manual work, improve decision quality, and strengthen member and provider service.
Serve as the claims analytics domain lead, connecting operational questions to data, insights, decisions, and actions.
Support enterprise actuarial reserving and Cost of Care initiatives through claims expertise, analytics partnership, and operational insight.
Partner with Finance, Actuarial, Analytics, Technology, and Claims leaders to define priorities, requirements, controls, and success measures.
Oversee digital operations to support efficient, accurate, and timely claims processing.
Lead end-to-end solution delivery from opportunity definition and requirements through implementation, adoption, performance monitoring, and optimization.
Coordinate cross-departmental projects, resolve dependencies, establish decision rights, and maintain accountability for commitments.
Manage budgets and resource priorities to optimize value, delivery, and operational performance.
Design and implement pilots to test strategies, workflows, analytical approaches, AI, automation, and other innovative technologies.
Define pilot hypotheses, measures, controls, and decisions about scaling while balancing speed, risk, and operational readiness.
Monitor performance metrics and use insights to improve productivity, service quality, processing accuracy, and operations continuously.
Create feedback loops to strengthen models, automation, controls, processes, and frontline execution.
Collaborate with IT and other departments on technology upgrades, implementations, integration, and operating readiness.
Engage stakeholders to align objectives, surface tradeoffs, resolve barriers, and sustain adoption; communicate priorities, progress, risks, and outcomes to operational, technical, analytical, and executive audiences.
Promote responsible use of AI and automation through appropriate governance, controls, monitoring, and accountability.
Ensure regulatory compliance across digital claims operations and transformation initiatives; embed policies, controls, audit readiness, privacy, security, and risk-management expectations into solutions and operating practices.
Partner with Compliance, Legal, Risk, Technology, and Operations to identify, escalate, and resolve issues.
Lead and mentor a high-performance team, fostering collaboration, accountability, innovation, and continuous learning.
Identify talent and create development opportunities that build succession depth and future-ready capabilities.
Hire, train, coach, counsel, and evaluate direct reports.
Build capability across claims operations, analytics, digital product leadership, process optimization, AI, automation, and change execution.