Vice President, Clearinghouse & Payer Operations - Experian Health
WFA Digital Insight
The demand for experienced leaders in healthcare operations has surged, with a 25% increase in job postings over the last year. As the healthcare industry continues to evolve, the need for strategic visionaries who can navigate complex payer networks and drive operational excellence is more pressing than ever. With Experian Health's commitment to innovation and customer satisfaction, this Vice President role offers a unique opportunity to make a lasting impact. Candidates should be well-versed in healthcare EDI standards, have a proven track record in operational leadership, and be prepared to drive transformation initiatives. Before applying, it's essential to understand the current landscape of healthcare operations and the role that Experian Health plays in it.
Job Description
About the Role
The Vice President, Clearinghouse & Payer Operations at Experian Health is a pivotal role that requires strategic leadership and operational expertise. As a key member of the executive team, you will be responsible for driving the performance, availability, scalability, and regulatory compliance of mission-critical electronic data interchange transactions. Your day-to-day will involve collaborating with cross-functional teams, including Engineering, InfoSec, and Product, to support platform resilience, modernization, and capacity planning. You will also serve as the executive escalation point for payer-related incidents, outages, and performance issues, ensuring that Experian Health's clients receive the highest level of service.The healthcare industry is undergoing a significant transformation, with the shift towards value-based care and the increasing importance of data-driven decision making. As a result, the role of clearinghouse and payer operations has become more critical than ever. You will be at the forefront of this transformation, leveraging Experian's data, analytics, and automation capabilities to enhance transaction efficiency, performance, contract adherence, and overall client outcomes.
You will report to the Chief Client Officer and will be responsible for defining and executing the clearinghouse and payer operations strategy, translating enterprise strategy into scalable operating models, and leading transformation initiatives focused on automation, AI-driven operations, and modernization.
What You Will Do
- Define and execute the clearinghouse and payer operations strategy in alignment with Experian Health's growth, margin, and platform modernization objectives
- Translate enterprise strategy into scalable operating models, KPIs, and service-level commitments across payer-facing clearinghouses
- Lead transformation initiatives focused on automation, AI-driven operations, and modernization
- Own operational budgets, forecasting, and cost management for clearinghouse and payer operations
- Ensure high availability, throughput, accuracy, and SLA conformance across transaction types
- Partner with Engineering, InfoSec, and Product to support platform resilience, modernization, and capacity planning
- Oversee payer contracting, onboarding, connectivity, testing, certification, and ongoing operational performance
- Serve as the executive escalation point for payer-related incidents, outages, and performance issues
- Build strong operational partnerships with national and regional payers to improve acceptance rates, turnaround times, and data quality
- Ensure compliance with HIPAA, X12, CMS, FHIR, etc. state regulations, and payer contractual obligations
- Partner with Compliance, Legal, Security, and Privacy teams to manage audits, incidents, and regulatory changes
- Own operational risk management, business continuity planning, and disaster recovery readiness for transaction services
- Collaborate with Product Management and Engineering to align operational capabilities with Experian Health's product roadmap and new service launches
- Partner with Sales and Client Success to support large enterprise clients, strategic deals, and escalations
- Work closely with Data, Analytics, and Platform teams to leverage Experian assets for operational insights and payer optimization
What We Are Looking For
- 15+ years of applicable leadership experience in healthcare operations, clearinghouse services, payer operations, revenue cycle technology/services, or health IT
- Demonstrated experience leading large-scale, high-volume transaction processing organizations
- Deep expertise in healthcare EDI standards and transactions (837, 835, 270/271, 276/277, 278)
- Understanding of EPIC, Oracle, Meditech registration workflow
- Strong understanding of Excel and its applications in healthcare operations
- Experience with automation, AI-driven operations, and modernization initiatives
- Proven track record of driving operational excellence and transformation initiatives
- Excellent communication, collaboration, and leadership skills
- Ability to work in a fast-paced, dynamic environment and navigate complex payer networks
Nice to Have
- Experience with cloud-based technologies and platform modernization
- Knowledge of data analytics and its applications in healthcare operations
- Familiarity with regulatory requirements and compliance frameworks
- Certification in healthcare operations or a related field
- Experience working with cross-functional teams, including Engineering, InfoSec, and Product
Benefits and Perks
- Competitive salary and benefits package
- Opportunity to work with a leading healthcare technology company
- Collaborative and dynamic work environment
- Professional development and growth opportunities
- Flexible and remote work arrangements
- Access to cutting-edge technology and tools
- Comprehensive health insurance and wellness programs
- Generous PTO and holiday package
How to Stand Out
- Make sure to highlight your experience with healthcare EDI standards and transactions in your application.
- Develop a strong understanding of Experian Health's products and services, as well as the current landscape of healthcare operations.
- Be prepared to discuss your experience with automation, AI-driven operations, and modernization initiatives.
- Showcase your leadership skills and ability to drive operational excellence and transformation initiatives.
- Research the company culture and values to understand how you can contribute to Experian Health's mission.
- Prepare examples of how you have navigated complex payer networks and driven results in previous roles.
- Consider reaching out to current or former employees to gain insights into the company and role.
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