Senior Vice President, Claims Services – Solutions

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🏄 California, Florida – Remote

🏄 California – Remote 🐊 Florida – Remote

⏰ Full Time

🟠 Senior

👔 Vice President

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Imagenet LLC

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

📦 Logistics

📣 Marketing

💰 Private Equity Round on 2022-12

Healthcare • Logistics • Marketing

Imagenet LLC is a leading provider of business continuity services for healthcare organizations, specializing in digital mailroom solutions, claims adjudication, contact center operations, and workflow management. With over two decades of experience and a reputation for enhancing efficiency and accuracy, Imagenet partners with health plans to streamline processes and improve member satisfaction. Their services are designed to reduce claims turnaround times, increase processing capacities, and lower contact center wait times. By integrating scalable solutions tailored to specific needs, Imagenet enables healthcare organizations to accelerate productivity and mitigate operational challenges.

📋 Description

• 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 claims rule governance, operational knowledge management, version-controlled client instructions, and single-source-of-truth practices • Partner with Technology and Product teams to define 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 claims leadership organization capable of supporting growth and delivering on client commitments

🎯 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 • Meaningful California healthcare payer market experience is required • 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

🏖️ Benefits

• Opportunity to shape the strategy, operating model, technology roadmap, and client experience for a growing healthcare services organization • Executive sponsorship, visibility, and leadership responsibility • Opportunity to modernize operations, strengthen client partnerships, enhance technology-enabled service delivery, and help drive company growth