Vice President, Clearinghouse & Payer Operations - Experian Health

Job Description

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

Qualifications

• 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

Additional Information

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. 

Benefits/Perks:

• Comprehensive executive level total rewards package
• Flexible time off including unlimited vacation, volunteer time off, and 12 paid holidays
• Core benefits including medical, dental, vision, and matching 401K
• Explore all our exciting benefits here: https://yourexperianbenefits.com/cand-index.html