Client Solution Executive

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

📋 Description

• Act as an executive advisor to Client leadership regarding the modernization of claims platforms and enterprise transformation projects.

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

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

• Cultivate relationships with senior stakeholders from clients 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, which include program planning, scheduling, RAID management, stage-gate reviews, executive reporting, compliance, and risk management.

• Ensure that programs align with strategic goals and operational priorities.

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

• Supervise technical solution strategies and direct architectural decisions for dual-platform claims processing environments.

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

• Guarantee the integration of data, reporting, and operational performance capabilities.

• Assess alternative solutions and propose approaches that balance cost, risk, and business value.

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

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

• Identify areas for process improvement and operational efficiencies.

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

• Lead the alignment of business and technology across Facets, HealthEdge, and other supporting enterprise systems.

• Facilitate integration planning, process harmonization, organizational readiness, and planning for future-state implementations.

• Advocate for stakeholder engagement and strategies for executive sponsorship.

• Oversee readiness assessments, adoption planning, communication, and change enablement initiatives.

• Provide executive consulting support for new initiatives and strategic opportunities.

• Recommend solutions for operational, technological, and business challenges.

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

⛳️ Requirements

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

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

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

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

• Comprehensive understanding of claims administration, payment integrity, operations, and healthcare technology ecosystems.

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

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

• Proven capability to manage complex engagements involving multiple vendors.

• Experience with HealthEdge, Facets, or other core administration platforms is preferred.

• Certifications such as PMP, PgMP, Lean Six Sigma, TOGAF, SAFe, or equivalent are preferred.

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

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

• Experience in establishing or leading Enterprise PMOs is preferred.

🏝️ Benefits

• A variety of health and dental plans with access to nationally recognized networks.

• Vision benefits included.

• Comprehensive wellness program.

• Employee assistance program available for employees and their families.

• Competitive salary offerings.

• Retirement savings plans available.

• Company-funded disability and life insurance.

• Opportunities for pre-tax savings (HSA and/or FSA).

• Professional development programs offered.

• Options for remote work.

• Generous paid-time-off policy.

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