Program Manager

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

📋 Description

• Oversee the comprehensive planning, execution, governance, and delivery of all activities related to claims implementation.

• Work in close collaboration with product managers and leaders involved in Provider Data, Configuration (including provider contracts, benefits, utilization management, and business rules), and Capitation to ensure a smooth migration, accurate claims adjudication, and operational readiness for launch.

• Responsible for the full implementation and resolution of issues within the QNXT Claims workstream, facilitating the complete transition from the IKA platform.

• Manage the claims implementation strategy across operations, configuration, testing, data conversion, training, cutover, and stabilization post-go-live.

• Maintain RAID logs, decision logs, and status updates.

• Ensure alignment among Claims, Provider Data, Benefits, Utilization Management, and Capitation to guarantee precise future-state claims adjudication, pricing, and payments.

• Direct daily collaboration with external implementation consultants and software vendors to keep scope, timelines, deliverables, and architectural decisions aligned.

• Lead the preparations for system testing, defect triage, mock conversions, go-live cutover, and post-implementation stabilization while verifying contingency and readiness plans.

• Actively identify execution risks, workflow deficiencies, and dependency challenges to protect project timelines, claims accuracy, and stakeholder trust.

⛳️ Requirements

• Bachelor’s degree in Business, Health Administration, Information Systems, or a related discipline (or an equivalent combination of education and experience).

• At least 6 years of relevant experience in a health plan, managed care, or healthcare organization.

• Required hands-on experience with QNXT (or a directly comparable core administrative platform).

• Extensive knowledge of healthcare payer claims operations and the complete claims lifecycle (including adjudication, pricing, payment, and interactions with provider/benefit configuration).

• Demonstrated experience in leading large, cross-functional system implementations or platform migrations that involve data conversion, system testing, defect triage, mock conversions, cutover planning, and stabilization at go-live.

• Advanced proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Teams), Visio, Access, and SQL.

• Capability to work standard PST business hours (Monday – Friday, 8:00 AM – 5:00 PM PST).

🏝️ Benefits

• Health insurance

• 401(k) matching

• Flexible work hours

• Paid time off

• Remote work options