Senior Manager, Claims Vendor Management

The Senior Manager, Claims Vendor Management will establish and lead Pie's comprehensive Claims Vendor Management program for all strategic claims vendors, with significant responsibility for oversight of high-risk managed care program vendors. This role oversees the full spectrum of Claims vendor relationships including managed care services (medical bill review, pharmacy benefit management, utilization review, provider networks), legal vendors (law firms and litigation support), investigative services, support vendors (transportation, translation), and API-integrated technology vendors. The Senior Manager is responsible for developing and executing a comprehensive vendor strategy, including implementing a sunset program to eliminate redundant contracts, establishing a formal RFP process for competitive vendor selection, and leading contract negotiations and renegotiations to optimize value and performance across all vendor categories. This role requires exceptional relationship management skills, advanced analytical capabilities to identify cost reduction opportunities, and the ability to collaborate across Claims, Legal, Finance, and Procurement to drive vendor performance improvements and ensure compliance with billing practices.

How You'll Do It

Vendor Management Program Development

• Establish and implement a comprehensive Claims Vendor Management program for Pie's strategic claims vendors
• Develop and lead vendor management strategy for the Claims Department in partnership with Claims leadership
• Build and manage a vendor management team to support strategic initiatives, including leadership oversight of direct reports
• Create and maintain a centralized repository of all vendor contracts with visibility across departments
• Implement vendor performance management frameworks and accountability structures
• Develop policies, procedures, and work plans that affect the department and may have company-wide impact

Managed Care Vendor Oversight

• Provide high-level oversight of critical managed care program vendors with significant focus on medical bill review, pharmacy benefit management, utilization review, and provider networks
• Ensure managed care vendors deliver quality services that support medical cost containment objectives
• Monitor compliance with contractual obligations and service level agreements for high-risk managed care vendor relationships
• Collaborate with Senior Director, Managed Care Services on vendor strategy and performance
• Assess vendor performance impact on medical loss costs and claim outcomes
• Lead initiatives to optimize managed care vendor portfolios and drive cost savings

Comprehensive Vendor Portfolio Management

• Oversee all Claims vendor categories including legal vendors (law firms and litigation support), investigative services, support vendors (transportation, translation), and API-integrated technology vendors
• Develop vendor management strategies tailored to the unique requirements of each vendor category
• Balance strategic focus on high-impact managed care vendors while maintaining effective oversight of all other vendor types
• Ensure consistent application of vendor management standards across diverse vendor categories
• Coordinate vendor relationships to support seamless Claims operations and optimal outcomes 

Strategic Vendor Initiatives

• Implement a sunset program to identify and eliminate redundant or underperforming vendor contracts across all vendor categories
• Establish and manage a formal RFP process to ensure competitive and transparent vendor selection
• Lead contract negotiations, renewals, and renegotiations to drive cost savings and improved terms for Pie
• Develop sourcing strategies in collaboration with internal Claims leadership to achieve cost reductions
• Analyze internal vendor costs against market forces to reduce Pie's claim costs and gain competitive advantages
• Drive strategy and success of larger vendor initiatives that contribute to multiple areas of the organization

Vendor Performance Management

• Set up and facilitate quarterly or annual meetings with Claims and vendor executives across all vendor categories to discuss performance and action items
• Collect and collate vendor performance feedback and review vendor spend and billing practices for managed care, legal, investigative, support, and technology vendors
• Establish KPIs to monitor vendor performance and ensure accountability and continuous improvement across all vendor types
• Perform vendor billing audits and lead vendor spend reviews to identify incorrect billing practices
• Serve as the central point of contact for strategic claims vendors across all categories

Process Improvement & Compliance

• Lead the transition of vendors to improved billing and bulk billing practices
• Implement agreed plans with Claims leadership to optimize billing processes
• Ensure compliance with billing practices and enterprise standards
• Partner with Claims leadership, Legal, Finance, and Procurement to ensure alignment and compliance
• Demonstrate project management skills to drive vendor management initiatives and provide regular updates

Cross-Functional Collaboration

• Collaborate with cross-functional teams to support product launches, operational needs, and strategic goals
• Partner with Claims Operations, Regulatory Compliance, and Claims Adjudication teams on vendor-related matters
• Work closely with Finance on budget management and cost containment initiatives
• Coordinate with Legal on contract reviews, negotiations, and compliance matters

The Right Stuff

Required Experience & Education

• Bachelor's degree in Business Administration, Finance, Supply Chain Management, or related field; Master's degree preferred
• 10+ years of experience in vendor management, procurement, or strategic sourcing
• 5+ years of experience in insurance industry, preferably in claims operations or vendor management
• 3+ years of people management experience, including oversight of managers or team leads
• Proven track record of leading vendor contract negotiations and achieving significant cost savings
• Experience developing and implementing vendor management programs from the ground up
• 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
• Deep expertise in 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
• Experience managing API-integrated technology vendors and understanding system integration requirements

Strategic & Analytical Expertise

• Advanced analytical skills with ability to evaluate vendor performance data, identify cost reduction opportunities, and apply conceptual thinking to complex organizational objectives
• Experience conducting vendor billing audits and comprehensive spend analysis across multiple vendor categories
• Strong understanding of RFP processes, contract negotiation strategies, and vendor selection criteria for both operational and managed care vendors
• Ability to benchmark vendor costs against market rates and industry standards
• Experience developing and implementing sunset programs for vendor portfolio optimization
• Proficiency with contract management systems and vendor performance tracking tools
• Ability to evaluate complex variables and apply analytical and critical thinking skills to cross-functional vendor projects

Relationship Management & Communication

• Exceptional relationship management skills with ability to influence senior executives and vendor partners
• Advanced communication skills to present complex vendor analysis and recommendations to leadership
• Proven ability to build consensus among diverse stakeholders including Claims, Legal, Finance, and Procurement
• Experience managing vendor relationships at the executive level
• Strong negotiation skills with demonstrated ability to achieve favorable contract terms

Leadership & Team Development

• Experience building and leading teams to execute strategic vendor management programs, including oversight of experienced professionals and subordinate managers
• Ability to develop and implement enterprise-wide processes and standards
• Track record of driving organizational change and process improvement initiatives
• Demonstrated leadership in cross-functional environments with ability to establish objectives, policies, and work plans
• Highly advanced ability to establish psychological safety for team members to test, learn, and grow
• Skilled in coaching team members toward self-sufficiency through effective questions, guidance, empowerment, and accountability
• Experience advising team members on moderately complex vendor management matters

M4 Senior Manager Level Competencies

• Disciplinary and functional expertise in vendor management across multiple vendor categories is sought out by others across the organization
• Typically directly manages two or more disciplines (managed care vendors, legal vendors, investigative services, support vendors, and technology vendors) or a department
• Drives strategy and success of larger vendor projects that contribute to multiple areas of the organization
• Works on issues where analysis requires conceptual thinking and in-depth knowledge of organizational objectives
• Oversees experienced professionals and may be responsible for subordinate managers or team leads
• Develops, modifies, and executes processes and procedures that affect the department and may have company-wide impact
• Advanced ability in demonstrating curiosity, tenacity, flexibility, and adaptability
• Highly advanced ability to challenge self consistently, seek to understand by questioning assumptions, and adapt to changes with increasing speed
• Advanced ability in presenting cross-functional perspectives in a direct and open manner and proactively engaging in difficult feedback
• Highly advanced ability to anticipate, analyze, and solve highly complex problems and offer strategic insight within the vendor management function
• Advanced ability to achieve cross-functional goals and build buy-in for complex vendor proposals and projects

The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process.

Compensation & Benefits 

• Competitive cash compensation
• Comprehensive health plans
• Generous PTO
• Future focused 401k match
• Generous parental and caregiver leave
• Our core values are more than just a poster on the wall; they’re tangibly reflected in our work 

Making every part of working with us "Easy as Pie" - including our offer process. When we find someone we'd like as a Pie-oneer (a member of our team), we move quickly to put together a fair offer based on your skills, experience, location, and compensation expectations.

Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members.

Location Information 

Unless otherwise specified, this role is remote. Remote team members must live and work in the United States (territories excluded) and have access to reliable, high-speed internet.

Additional Information

Pie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic.

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