Manager, Claims Vendor Management

🔥 7 minutes ago

🇺🇸 United States – Remote

💵 $110k - $140k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🛒 Procurement

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Pie Insurance

WebsiteLinkedInAll Job Openings

201 - 500 employees

🛡️ Insurance

💳 Fintech

🤝 B2B

Insurance • Fintech • B2B

Pie Insurance is transforming small business insurance by making it less expensive, simpler, and more transparent for small business owners. With a team of seasoned technology and insurance experts, Pie Insurance is dedicated to enhancing the insurance experience, particularly focused on workers' compensation and InsureTech innovations.

📋 Description

• Lead Pie's Claims Vendor Management program for assigned strategic claims vendors, with a strong focus on managed care program vendors • Manage relationships with managed care, legal, investigative, support, and API-integrated technology vendors • Execute vendor management strategy with Claims leadership • Develop vendor management team members and support strategic initiatives • Create and maintain a centralized repository of vendor contracts • Implement vendor performance management frameworks and accountability structures • Oversee medical bill review, pharmacy benefit management, utilization review, and provider network vendors • Monitor contractual obligations, service level agreements, vendor performance, medical loss costs, and claim outcomes • Support vendor portfolio optimization and cost savings initiatives • Run formal RFP processes and lead contract negotiations, renewals, and renegotiations • Analyze vendor costs against market forces • Facilitate quarterly or annual performance meetings with Claims and vendor stakeholders • Review vendor spend and billing practices; establish KPIs and perform billing audits • Support improved billing and bulk billing practices and ensure compliance with enterprise standards • Collaborate with Claims, Legal, Finance, Procurement, Claims Operations, Regulatory Compliance, and Claims Adjudication teams • Work closely with Finance on budget management and cost containment initiatives • Coordinate with Legal on contract reviews, negotiations, and compliance matters • Apply project management skills and provide regular updates

🎯 Requirements

• Bachelor's degree in Business Administration, Finance, Supply Chain Management, or related field • 6+ years of experience in vendor management, procurement, or strategic sourcing • 3+ years of experience in the insurance industry, preferably in claims operations or vendor management • 1+ years of experience leading or mentoring team members; direct people management experience a plus • Track record of leading vendor contract negotiations and achieving cost savings • Experience supporting or implementing vendor management programs • Strong understanding of workers' compensation and managed care vendors landscape, as well as legal, investigative, and support vendor categories; experience with commercial auto vendors is a plus • Working knowledge of managed care services including medical bill review, pharmacy benefit management, utilization review, and provider networks • Knowledge of legal vendor management including law firm relationships and litigation support services • Understanding of investigative services, transportation, translation, and other ancillary claims support vendors • Exposure to API-integrated technology vendors and understanding of system integration requirements • Remote team members must live and work in the United States (territories excluded) and have access to reliable, high-speed internet

🏖️ Benefits

• Competitive cash compensation • Comprehensive health plans • Generous PTO • Future focused 401k match • Generous parental and caregiver leave • Discretionary bonuses may be granted annually to eligible team members

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