Staff VP CX Solutions

Anticipated End Date:

2025-12-19

Position Title:

Staff VP CX Solutions

Job Description:

Staff VP CX Solutions

Location:   May be located in Indianapolis, IN, Atlanta, GA, Chicago, IL or Woodland Hills, CA.

This role requires associates to be in-office at least 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.  Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Summary

Responsible for defining the value stream strategy to redesign and implement end to end stakeholder journeys.

Position Responsibilities

Lead Enterprise-Level Strategic Initiatives Across HBO

Drive the strategy and execution of key initiatives within Health Benefits Operations (HBO), ensuring alignment with enterprise priorities and market growth goals. This includes:

• Identifying new business models that fundamentally disrupt the status quo

• Bringing an externally informed, market-driven strategy to revenue cycle, claims integrity, and digital enablement

• Serving as a senior-level thought partner to SVPs and other executives

Develop and Oversee Revenue Cycle Management (RCM) Strategy

Own the end-to-end strategy for shifting from reactive “pay-and-chase” models to proactive “avoidance-first” models, including:

• Partnering with medical policy, clinical, SIU, provider engagement, and network teams

• Designing upstream interventions to eliminate avoidable overpayments

• Building monitoring mechanisms that track reductions in recoveries, adjustments, and leakage

• Influencing platform enhancements and data use that enable “first-pass right” outcomes

Build and Lead External Vendor & Partnership Strategy

Establish and mature a vendor ecosystem that supports the future-state RCM and claims strategy through:

• Strategic sourcing and vendor selection

• Evaluating niche, emerging, and tech-forward partners (AI, RPA, EDI, integrity, analytics, platform innovators)

• Driving integration and performance management models

• Setting a vision for vendor consolidation or diversification based on ROI and scalability

Focus on creating shared-risk models, performance guarantees, and innovative value structures aligned to “avoidance” and improved first-pass payment accuracy.

Champion EDI & Data Partnerships to Achieve “Claims in Good Order”

Lead EDI, clearinghouse, and data partnership strategies that fundamentally improve claim quality at the point of submission. Responsibilities include:

• Creating alignment across providers, TPAs, clearinghouses, and internal edit engines

• Moving the enterprise toward universal “right first time” claims through better data flow, pre-adjudication checks, and digitally enforced requirements

• Embedding claim-quality expectations into provider contracts and enablement programs

• Scaling “front-door integrity” and EDI rulesets

This leader will drive interoperability and partner solutions that reduce rework, appeals, adjustments, and post-pay audit pressures.

Oversee Platform Migrations Within Key Subsidiaries

Guide transformation strategies and execution related to platform shifts across subsidiaries, including:

• Defining future-state platform capabilities

• Aligning journey redesign with platform modernization

• Prioritizing platform investments based on business value and ROI

• Ensuring readiness plans, migration playbooks, capability mapping, and phased rollout strategies

• Driving consistency, reuse, and value capture across markets and subsidiaries

This includes working with Technology, Digital, Market Leadership, and cross-functional SMEs to ensure platform migrations enhance—not just replicate—current state operations.

Serve as an Enterprise Innovator and Disruptor

Bring a forward-thinking view that challenges legacy operating models and fosters:

• Outside-in innovation

• Data-driven decision making

• Partnerships with startups, fintech, healthtech, and RCM innovators

• Accelerate