Client Solution Executive

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Act as an executive advisor to client leadership regarding initiatives for claims platform modernization and enterprise transformation.

• Facilitate strategic planning meetings to define program objectives, success metrics, and strategies for value realization.

• Create executive communications, presentations for steering committees, and updates on program status.

• Cultivate relationships with senior stakeholders at the client and vendor leadership teams.

• Offer thought leadership on operations for healthcare payers, claims processing, and best practices in modernization.

• Establish and manage EPMO governance frameworks, encompassing program planning, scheduling, RAID management, stage-gate reviews, executive reporting, compliance, and risk management.

• Ensure that programs are aligned with strategic goals and operational priorities.

• Lead cross-functional teams to promote accountability and effective execution.

• Oversee the strategy for technical solutions and guide architectural decisions for dual-platform claims processing environments.

• Collaborate with architects, solution engineers, and technical subject matter experts to develop scalable solutions.

• Ensure integration of data, reporting, and operational performance capabilities.

• Assess solution alternatives and recommend approaches that balance cost, risk, and business value.

• Provide executive oversight for initiatives related to claims adjudication validation and payment accuracy.

• Facilitate parity testing and quality assurance across various claims platforms.

• Identify opportunities for process improvements and operational efficiencies.

• Ensure adherence to contractual, regulatory, and client-specific requirements.

• Lead alignment across Facets, HealthEdge, and supporting enterprise systems.

• Facilitate planning for integration, process harmonization, organizational readiness, and the implementation of future states.

• Promote stakeholder engagement, executive sponsorship, readiness assessments, adoption planning, communication, and change enablement.

• Provide executive consulting for emerging initiatives and strategic opportunities.

• Analyze challenges and propose actionable solutions.

• Identify opportunities to enhance performance, mitigate risk, and expedite modernization.

• Support business development, growth initiatives, and solution pursuits through strategic leadership.

⛳️ Requirements

• Bachelor's degree in Healthcare Administration, Information Systems, Business Administration, Computer Science, or a related field.

• 15+ years of experience in healthcare payer, managed care, government healthcare, or healthcare technology.

• Over 10 years of experience leading large-scale business transformation, PMO, or modernization initiatives.

• Proven experience in supporting complex healthcare payer organizations or government healthcare programs.

• Extensive knowledge of claims administration, payment integrity, operations, and healthcare technology ecosystems.

• Experience in leading executive governance, stakeholder management, and enterprise-level program delivery.

• Strong understanding of enterprise architecture, systems integration, and digital transformation.

• Demonstrated capability to manage complex, multi-vendor engagements.

• Preferred experience with HealthEdge, Facets, or other core administration platforms.

• Preferred certifications include PMP, PgMP, Lean Six Sigma, TOGAF, SAFe, or equivalent.

• Experience supporting Medicare, Medicaid, Commercial, or Government Programs is preferred.

• Background in enterprise transformation consulting, advisory services, or executive program leadership is preferred.

• Preferred experience in establishing or managing Enterprise PMOs.

🏝️ Benefits

• A variety of health and dental plans featuring nationally recognized networks.

• Vision benefits.

• Comprehensive wellness program.

• Employee assistance program available for employees and their families.

• Competitive salary.

• Retirement savings plans.

• Company-paid disability and life insurance.

• Pre-tax savings opportunities (HSA and/or FSA).

• Opportunities for professional development.

• Flexible options for remote work.

• Generous paid-time-off program.

• Flexible scheduling to accommodate vacations, illnesses, life events, and unforeseen circumstances.