Manager, Claims Vendor Management

The Manager, Claims Vendor Management leads Pie's Claims Vendor Management program for assigned strategic claims vendors, with a strong focus on oversight of managed care program vendors. This role manages 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 Manager executes vendor strategy in partnership with Claims leadership, including supporting a sunset program to eliminate redundant contracts, running a formal RFP process for competitive vendor selection, and leading contract negotiations and renegotiations to optimize value and performance within their assigned vendor categories. This role requires strong relationship management skills, solid 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

• Support implementation of Pie's Claims Vendor Management program for assigned strategic claims vendors.
• Execute vendor management strategy for the Claims Department in partnership with Claims leadership.
• Support and help develop vendor management team members contributing to strategic initiatives.
• Create and maintain a centralized repository of all vendor contracts with visibility across departments.
• Implement vendor performance management frameworks and accountability structures.
• Support policies, procedures, and work plans that affect the team and contribute to department-wide initiatives.

Managed Care Vendor Oversight

• Provide oversight of managed care program vendors with a 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 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.
• Support initiatives to optimize managed care vendor portfolios and drive cost savings.

Comprehensive Vendor Portfolio Management

• Manage day-to-day vendor relationships across legal vendors (law firms and litigation support), investigative services, support vendors (transportation, translation), and API-integrated technology vendors.
• Apply vendor management strategies tailored to the unique requirements of each vendor category.
• Balance focus on managed care vendors while maintaining effective oversight of other assigned 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

• Support a sunset program to identify and eliminate redundant or underperforming vendor contracts across assigned vendor categories.
• Run 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.
• Support sourcing strategies in collaboration with Claims leadership to achieve cost reductions.
• Analyze internal vendor costs against market forces to reduce Pie's claim costs and gain competitive advantages.
• Contribute to the strategy and success of larger vendor initiatives led by Claims leadership.

Vendor Performance Management

• Facilitate quarterly or annual meetings with Claims and vendor stakeholders 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 support accountability and continuous improvement.
• Perform vendor billing audits and support vendor spend reviews to identify incorrect billing practices.
• Serve as a point of contact for assigned strategic claims vendors.

Process Improvement & Compliance

• Support 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.
• Apply project management skills to support 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.
• 6+ years of experience in vendor management, procurement, or strategic sourcing.
• 3+ years of experience in the insurance industry, preferably in claims operations or vendor management.
• 1+ years of experience leading or mentoring team members; direct people management experience a plus.
• Track record of leading vendor contract negotiations and achieving cost savings.
• Experience supporting or implementing vendor management programs.
• 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.
• Working knowledge of 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.
• Exposure to API-integrated technology vendors and understanding of system integration requirements.

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.