Staff VP Digital Claims Operations

Anticipated End Date

2026-11-30

Position Title

Staff VP Digital Claims Operations

Job Description

Staff Vice President, Digital Claims Operations

Location:   May be located in any Elevance Health PulsePoint office preferably in Indianapolis, IN, Atlanta, GA, Mason, OH, Richmond, VA, Norfolk, VA, Chicago, IL or Woodland Hills, CA.

This role requires associates to be in-office 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 if candidates reside within a commuting distance from an office.

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

The Staff Vice President, Digital Claims Operations is responsible for driving 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 enhance operational efficiency, processing accuracy, and service quality across claims management.

The leader develops and executes a digital claims strategy aligned with company objectives and provides hands-on leadership for transformation initiatives involving AI, automation, advanced analytics, and end-to-end solution delivery. Serving as the claims analytics domain lead, the executive supports enterprise actuarial reserving and Cost of Care initiatives while managing the intersection of operations, analytics, and technology with deep claims expertise.

Leadership and Culture

The successful executive will combine enterprise perspective, disciplined execution, innovation, and strong stakeholder leadership. They will build a collaborative, high-performance team; identify and develop talent; clarify accountability; and foster an environment grounded in trust, inclusion, continuous learning, and measurable outcomes.

Strategic Mandate and Outcomes

Role Mandate

• Develop and execute a digital claims strategy that aligns with company objectives and advances operational, financial, and service outcomes.

• Integrate strategic planning, process optimization, analytics, AI, automation, and technology implementation into a cohesive transformation agenda.

• Lead the claims analytics domain and support enterprise actuarial reserving, Cost of Care, and other priority business initiatives.

• Oversee digital claims operations and the delivery of end-to-end solutions that improve efficiency, accuracy, productivity, and service quality.

• Design and implement pilots to test strategies, validate value, assess scalability, and accelerate adoption of innovative capabilities.

• Ensure digital claims operations meet applicable regulatory, compliance, control, and risk-management requirements.

Illustrative Measures of Success

• A clear digital claims roadmap is established, aligned to business priorities, and translated into accountable delivery plans.

• AI, automation, analytics, and process changes produce measurable improvements in productivity, quality, accuracy, and service performance.

• Pilots are designed with defined hypotheses, performance measures, governance, and decisions regarding scale, refinement, or discontinuation.

• Claims analytics effectively support operational decisions, actuarial reserving, and Cost of Care priorities.

• End-to-end solutions are delivered with strong operating readiness, adoption, stakeholder alignment, and sustained benefit realization.

• Budgets, risks, dependencies, and cross-departmental commitments are managed with transparency and discipline.

• Digital claims operations consistently meet regulatory and compliance expectations.

Position Responsibilities

Digital Claims Strategy and Transformation

• 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.

• Provide hands-on leadership for 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.

Claims Analytics and Enterprise Partnership

• Serve as the analytics domain lead for claims, connecting operational questions to data, insights, decisions, and actions.

• Support enterprise actuarial reserving and Cost of Care initiatives through claims domain expertise, analytics partnership, and operational insight.

• Lead the intersection of claims operations, analytics, and technology, ensuring solutions are grounded in business needs and claims realities.

• Partner with Finance, Actuarial, Analytics, Technology, and Claims leaders to define priorities, requirements, controls, and success measures.

Digital Operations and End-to-End Solution Delivery

• Oversee digital operations to support efficient, accurate, and timely claims processing.

• Lead delivery of end-to-end solutions, 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.

Innovation, Pilots, and Performance Management

• Design and implement pilots to test strategies, workflows, analytical approaches, AI, automation, and other innovative technologies.

• Define pilot hypotheses, measures, controls, and scale decisions while balancing speed, risk, and operational readiness.

• Monitor performance metrics and use insights to drive productivity improvement, service quality, processing accuracy, and continuous improvement.

• Create feedback loops that strengthen models, automation, controls, processes, and frontline execution.

Technology Enablement and Stakeholder Engagement

• Collaborate closely with IT and other departments to ensure seamless technology upgrades, implementations, integration, and operating readiness.

• Maintain strong stakeholder engagement to align objectives, surface tradeoffs, resolve barriers, and sustain adoption.

• Communicate priorities, progress, risks, and outcomes clearly to operational, technical, analytical, and executive audiences.

• Promote responsible use of AI and automation with appropriate governance, controls, monitoring, and accountability.

• Compliance and Risk

• Ensure regulatory compliance across digital claims operations and transformation initiatives.

• Embed applicable policies, controls, audit readiness, privacy, security, and risk-management expectations into solution design and operating practices.

• Partner with Compliance, Legal, Risk, Technology, and Operations to identify, escalate, and resolve issues.

People Leadership

• 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 the performance of direct reports.

• Build capability across claims operations, analytics, digital product leadership, process optimization, AI, automation, and change execution.

Position Requirements

Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 15 years of