Staff VP Provider Data Solutions

Anticipated End Date:
2026-11-06
Position Title:
Staff VP Provider Data Solutions
Job Description:
Staff VP, Provider Data Solutions
Anticipated Job Posting End Date: 11/6/2026
Location: May be located in any Elevance Health PulsePoint office preferably in Indianapolis, IN, Mason, OH, Chicago, IL, Denver, CO, Atlanta, GA, Tampa, FL, or New York, NY.
This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Summary
Provider data underpins access to care, claims accuracy, pricing and payment integrity, care navigation, provider search, network adequacy, value-based care, medical cost management, regulatory compliance, customer service, and digital experience. The platforms and standards support ~50M members and ~4M providers and facilities across dozens of markets and multiple lines of business, enabling a scale of provider data changes in 1B+ transactions.
This is the operations, technology, solutions, and governance side of provider data: the bridge between business and technology for transformation, modernization, automation, system implementation, business architecture, provider lifecycle platforms, contract digitization, data consumption, network intelligence, and pricing technology. The role also owns government-programs policy and rules, and a provider data quality program that translates policy and regulatory change into reimbursement requirements, fee-schedule specifications, business rules, data controls, monitoring, and issue detection – with traceability from policy through implementation.
The Staff Vice President, Provider Data Solutions owns a portfolio of transformational projects that deliver a connected, end-to-end experience for all lines of business. The role sets priorities and manages initiatives for core provider systems and platforms – work that depends on close partnership across regional provider operations, government programs, operations, legal, compliance, benefits, and third-party vendors.
The Staff Vice President drives enterprise-wide improvement using Lean and Six Sigma methods to build efficiency and elevate quality and user experience, while bringing modern automation and AI into operational processes – and keeps the organization aligned to enterprise strategy and regulatory requirements across a complex, highly regulated environment.
Position Responsibilities
Solutions Strategy, Modernization, and Portfolio Prioritization
Set the multi-year operations, technology, and solutions roadmap for core provider data platforms, sequencing modernization, automation, and retirement decisions against strategy, regulatory mandates, and affordability goals.
Lead issue management and impact analysis across the solutions and benefits operations organization, turning operational, regulatory, provider, and financial impacts into clear decisions and accountable resolution plans.
Prioritize and manage a large portfolio of data-management initiatives spanning provider lifecycle platforms, roster automation, digital rules, data quality programs, contract digitization, pricing technology, and network intelligence.
Own product management for the provider data portfolio — requirements, design decisions, release planning, adoption, and measurable benefit realization.
Bring modern automation and AI — including roster automation, rules-engine capabilities, and data self-healing — into operations, with clear governance, controls, and measurable outcomes.
Lead enterprise-wide improvement using Lean and Six Sigma to raise efficiency, quality, cycle time, and user experience for provider-facing and internal users alike.
Delivery, Implementation, and Operational Execution
Own “contract to accurate payment” journey end to end, partnering with operations, business units, technology, and compliance on turnaround time, claim-pend inventory, pricing accuracy, utilization management, find care, capitation, value-based contracts, and leakage.
Coordinate transformation changes with end-to-end operational workflows, change management, communications, adoption standards, and technology changes are accurate every time.
Drive simplification, standardization, automation, productivity, and cost efficiency across the provider lifecycle and operating expenses driving 10% YOY expense reduction.
Deliver on time and on budget through disciplined intake, prioritization, resourcing, milestone management, and executive reporting.
Accountable for migrations, integrations, acquisitions, and market launches that touch provider data.
Data Architecture, Policy Translation, Governance, and Compliance
Own enterprise provider data models, definitions, standards, and integration architecture that every provider data function builds to — one authoritative standard across platforms and consumers.
Translate government-programs policy and regulatory change into reimbursement requirements, fee-schedule specifications, business rules, and data controls, with traceability from policy through implementation and ongoing monitoring.
Maintain compliance with enterprise strategy and regulatory requirements, including CMS, state Medicaid, NCQA, interoperability, and association obligations affecting provider data, directories, and pricing configuration.
Strengthen functionality, data efficiency, and quality through issue detection, automated controls, validation, monitoring, and root-cause remediation.
Govern AI and automation using a govern–map–measure–manage framework aligned to recognized industry standards, with third-party and continuity oversight for critical provider data pipelines and vendor concentration.
Cross-Functional and Enterprise Partnership
Build and sustain cross-functional partnerships with regional provider operations, business units, operations, legal, compliance, benefits, finance, and third-party vendors to deliver the portfolio.
Partner with enterprise technology and digital leaders on architecture decisions, delivery capacity, release management, and platform investment.
Engage health-plan and market leaders so solutions support growth, affordability, network strategy, client commitments, and market-specific needs.
Manage vendor and third-party relationships across the portfolio, including contracting, performance oversight, concentration risk, and continuity planning.
Represent provider data governance in executive forums, architecture and change-governance committees, regulatory discussions, and transformation initiatives.
Communicate with executive presence at every level, including direct engagement with large P&L owners, regulators, providers, compliance, audit, HR, and enterprise partners, to align strategy, operations, process, risk resolution, and business impact.
Financial, Performance, and Risk Accountability
Deliver financial goals, productivity commitments, quality targets, service-level expectations, and regulatory performance for the portfolio.
Manage the technology, solutions, and governance share of a nine-figure operating budget, including run, change, and vendor spend.
Coordinate budget planning, investment prioritization, business-case development, and resource allocation across operational, program, and implementation needs.
Influence medical cost management, claims and pricing accuracy, payment integrity, member access, and customer service through platform, rules, and data-quality outcomes.
Build scorecards and executive reporting to track transformation portfolio health, delivery progress, automation benefit, data quality, and compliance results.
Proactively identify, communicate, mitigate, and govern operational, technology, data, AI, third-party, and regulatory risk through the right enterprise channels.
People Leadership and Organizational Effectiveness
Hire, develop, and lead a sizable team across product, platform, automation, architecture, and policy-translation disciplines.
Lead a team of directors and senior individual-contributor leaders, maintaining a healthy span of control and avoiding unnecessary layers.
Build organizational capability in transformation portfolio ownership, business architecture, automation and AI enablement, data governance, regulatory translation, and program delivery.
Coach and develop leaders to strengthen performance, engagement, and succession depth across a multi-site onshore, offshore, and vendor workforce.
Create a culture of accountability, innovation, quality, continuous improvement, and collaboration, and align workforce planning and change management to current and future needs.
Bring the strategic vision, execution discipline, talent-building capability, stakeholder relationship management, and result