Manager, Claims Vendor Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee Pie's Claims Vendor Management program for designated strategic claims vendors, emphasizing managed care program vendors.

• Cultivate relationships with managed care, legal, investigative, support, and API-integrated technology vendors.

• Implement vendor management strategy in collaboration with Claims leadership.

• Mentor vendor management team members and assist in driving strategic initiatives.

• Establish and maintain a centralized repository for vendor contracts.

• Develop and enforce vendor performance management frameworks and accountability structures.

• Supervise medical bill review, pharmacy benefit management, utilization review, and provider network vendors.

• Track contractual obligations, service level agreements, vendor performance, medical loss costs, and claim outcomes.

• Aid in optimizing vendor portfolios and initiatives for cost savings.

• Manage formal RFP processes and steer contract negotiations, renewals, and renegotiations.

• Evaluate vendor costs in relation to market dynamics.

• Facilitate quarterly or annual performance evaluations with Claims and vendor stakeholders.

• Assess vendor spending and billing methods; set KPIs and conduct billing audits.

• Promote enhanced billing practices, including bulk billing, ensuring adherence to enterprise standards.

• Collaborate with Claims, Legal, Finance, Procurement, Claims Operations, Regulatory Compliance, and Claims Adjudication teams.

• Partner closely with Finance on budget management and cost containment strategies.

• Work with Legal on contract assessments, negotiations, and compliance issues.

• Utilize project management skills and provide consistent updates.

⛳️ Requirements

• Bachelor's degree in Business Administration, Finance, Supply Chain Management, or a related discipline.

• Over 6 years of experience in vendor management, procurement, or strategic sourcing.

• At least 3 years in the insurance sector, ideally in claims operations or vendor management.

• Minimum of 1 year leading or mentoring team members; direct people management experience is advantageous.

• Proven history of negotiating vendor contracts and realizing cost reductions.

• Experience in supporting or establishing vendor management programs.

• Strong knowledge of the workers' compensation and managed care vendor landscape, along with legal, investigative, and support vendor categories; familiarity with commercial auto vendors is a plus.

• Practical knowledge of managed care services such as medical bill review, pharmacy benefit management, utilization review, and provider networks.

• Understanding of legal vendor management, including relationships with law firms and litigation support services.

• Insight into investigative services, transportation, translation, and other ancillary claims support vendors.

• Exposure to API-integrated technology vendors and comprehension of system integration needs.

• Remote team members must reside and work in the United States (excluding territories) and possess 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 awarded annually to eligible team members.