About this role
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 objectivesTranslate enterprise strategy into scalable operating models, KPIs, and service-level commitments across payer-facing clearinghousesLead transformation initiatives focused on automation, AI-driven operations, and modernizationOwn operational budgets, forecasting, and cost management for clearinghouse and payer operationsClearinghouse Operations
Own end-to-end operational performance of Experian Health's real-time and batch clearinghousesEnsure high availability, throughput, accuracy, and SLA conformance across transaction typesPartner with Engineering, InfoSec and Product to support platform resilience, modernization, capacity planning, and redundancyPayer Network & Relationships
Oversee payer contracting, onboarding, connectivity, testing, certification, and ongoing operational performanceServe as the executive escalation point for payer-related incidents, outages, and performance issuesBuild strong operational partnerships with national and regional payers to improve acceptance rates, turnaround times, and data qualityCompliance, Risk & Reliability
Ensure compliance with HIPAA, X12, CMS, FHIR, etc. state regulations, and payer contractual obligationsPartner with Compliance, Legal, Security, and Privacy teams to manage audits, incidents, and regulatory changesOwn operational risk management, business continuity planning, and disaster recovery readiness for transaction servicesCross-Functional Leadership
Collaborate with Product Management and Engineering to align operational capabilities with Experian Health's product roadmap and new service launchesPartner with Sales and Client Success to support large enterprise clients, strategic deals, and escalationsWork 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 ITDemonstrated experience leading large-scale, high-volume transaction processing organizationsDeep expertise in healthcare EDI standards and transactions (837, 835, 270/271, 276/277, 278)Understanding of EPIC, Oracle, Meditech registration workflowStrong understanding of payer-provider workflows and reimbursement processesProven ability to lead cross-functional teams in complex, regulated environmentsExperience working with national and regional payer networksPreferred experience in operational transformation, automation, or AI-enabled healthcare operationsLeadership Competencies
Customer-first mindset aligned with Experian Health's mission to simplify healthcare paymentsData-driven decision making leveraging Experian analytics and insightsStrong executive communication and stakeholder managementChange leadership and continuous improvement orientationTalent development and inclusive leadership Our uniqueness is that we celebrate yours. Experian's people first, inclusive and purpose driven culture is multi award-winning; World's Best Workplaces™ 2025 (Fortune Global Top 25), Great Place To Work™ in 26 countries to name a few. Check out Experian Life on social or explore our Careers Site to understand why.
Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay range for this position is listed above. Within this range, individual pay is determined by work location and additional factors such as job-related skills, experience, and education. This position is also eligible for a variable pay opportunity and a comprehensive benefits package.
Experian is proud to be an Equal Opportunity Employer for all groups protected under applicable federal, state and local law, including protected veterans and individuals with disabilities. If you have a disability or special need that requires accommodation, please let us know at the earliest opportunity.
Recruitment Fraud Awareness - Experian's recruitment process is conducted only through authorised channels. Recruitment communications will only be sent from an @experian.com email address. Experian will never ask candidates to make any payment as part of an application, interview, assessment, onboarding, or recruitment process. To apply for roles or verify opportunities, please visit experian.com/careers.
Benefits/Perks:
Comprehensive executive level total rewards packageFlexible time off including unlimited vacation, volunteer time off, and 12 paid holidaysCore benefits including medical, dental, vision, and matching 401KExplore all our exciting benefits here: https://yourexperianbenefits.com/cand-index.html