Role: Technical Delivery Manager with Claims EXP
Location: Remote
Required Qualifications
10+ years of experience in healthcare payer organizations with practical knowledge of claims, adjudication, eligibility, enrollment, provider workflows, member workflows, and payer operations.
7+ years in technical delivery, program management, software delivery, project management, Scrum leadership, or a related role; demonstrated ownership of complex multi-team delivery.
Proven success leading at least one large modernization initiative involving legacy, claims, core administration, platform, architecture, data, cloud, or enterprise technology transformation.
Hands-on experience delivering healthcare EDI solutions or operations involving 837, 835, 270/271, 276/277, enrollment, acknowledgments, exception handling, or reconciliation.
Strong understanding of the software development lifecycle, including discovery, architecture, planning, development, testing, release, cutover, hypercare, and operational transition.
Experience managing integrated plans, milestones, commitments, capacity, dependencies, risks, recovery actions, and release readiness.
Ability to translate technical constraints and delivery evidence into clear forecasts, tradeoffs, decisions, and executive communications.
Experience operating in highly matrixed and ambiguous environments with evolving requirements, roadmaps, priorities, and architecture.
Proficiency with Jira, Confluence, Agile metrics, sprint governance, release planning, and risk-management practices.
Working knowledge of approved AI productivity tools, agents, reusable skills, prompts, automation, or workflow optimization.
Bachelor's degree or equivalent practical experience.
Preferred Qualifications
Direct experience with Aetna/CVS Health, Meritain Health, Elevance Health, UnitedHealthcare, Humana, Cigna, Centene, Molina, or another large payer.
Experience with platform decomposition, API enablement, event-driven architecture, real-time data services, cloud transformation, or distributed systems.
Familiarity with payer legacy applications, claims engines, EDI gateways, data platforms, business-rules engines, APIs, and operational processes.
Experience coordinating vendors, consulting firms, clearinghouses, or external delivery partners.
Practical DevOps, CI/CD, test automation, observability, release-readiness, dashboarding, or Power BI experience.
Relevant delivery, program-management, Agile, Scrum, SAFe, cloud, or healthcare-domain certifications.
Required Evidence of Impact
Candidates must provide concrete examples, not high-level statements, demonstrating:
The delivery or business problem that existed and why it mattered.
The actions personally taken, including decisions influenced, conflicts resolved, escalations led, and teams held accountable.
The metrics used to assess delivery health and guide intervention.
Measurable outcomes such as improved predictability or velocity, reduced slippage, shorter lead time, better release quality, fewer EDI rejections, faster claims processing, higher automation, reduced operational effort, or improved readiness.
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