Smarter business decisions. A better bottom line. Stronger relationships with patients.
That's what healthcare organizations experience using Experian Health's industry-leading solutions for revenue cycle management, identity management, patient engagement and care management. The Vice President, Clearinghouse & Payer Operations at Experian Health is responsible for the strategic leadership and operational execution of clearinghouse and payer-facing transaction services.
This role ensures the performance, availability, scalability, and regulatory compliance of mission-critical electronic data interchange transactions that connect providers, payers, and healthcare networks. Reporting to the Chief Client Officer, you will drive operational excellence across both real-time and batch clearinghouses, spanning claims, eligibility, remittance, prior authorization, and other payer connectivity services.
You will leverage Experian's data, analytics, and automation capabilities to enhance transaction efficiency, performance, contract adherence, and overall client outcomes. Key Responsibilities Strategic & Operational Leadership
- 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 Clearinghouse Operations
- Own end-to-end operational performance of Experian Health's real-time and batch clearinghouses
- Ensure high availability, throughput, accuracy, and SLA conformance across transaction types
- Partner with Engineering, InfoSec and Product to support platform resilience, modernization, capacity planning, and redundancy Payer Network & Relationships
- 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 Compliance, Risk & Reliability
- 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 Cross-Functional Leadership
- 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
- 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 payer-provider workflows and reimbursement processes
- Proven ability to lead cross-functional teams in complex, regulated environments
- Experience working with national and regional payer networks
- Preferred experience in operational transformation, automation, or AI-enabled healthcare operations Leadership Competencies
- Customer-first mindset aligned with Experian Health's mission to simplify healthcare payments
- Data-driven decision making leveraging Experian analytics and insights
- Strong executive communication and stakeholder management
- Change leadership and continuous improvement orientation
- Talent development and inclusive leadership