Program Manager

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

📋 Description

• Assume complete responsibility for the Claims Workstream in a large-scale transformation of the QNXT core platform.

• Oversee the entire migration process from the IKA platform to QNXT.

• Manage comprehensive planning, execution, governance, issue resolution, and delivery of claims-related implementation activities.

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

• Maintain RAID logs, decision logs, and provide status reports.

• Coordinate the Claims, Provider Data, Benefits, Utilization Management, and Capitation workstreams.

• Ensure precise future-state claims adjudication, pricing, and payment processes.

• Facilitate daily collaboration with external implementation consultants and software vendors.

• Keep the scope, timelines, deliverables, and architectural decisions aligned and on schedule.

• Lead the preparation for system testing, defect triage, mock conversions, go-live cutover, and post-implementation stabilization.

• Validate contingency and readiness strategies.

• Identify execution risks, workflow gaps, and dependency challenges.

• Protect project timelines, claims accuracy, and stakeholder trust.

• Align senior leadership, technical teams, consultants, and vendors on unified priorities.

• Resolve obstacles before they impact critical-path timelines.

⛳️ Requirements

• Bachelor's degree in Business, Health Administration, Information Systems, or a related field, or an equivalent combination of education and experience.

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

• Required hands-on experience with QNXT or a similar core administrative platform.

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

• Proven track record in leading large, cross-functional system implementations or platform migrations, including data conversion, system testing, defect triage, mock conversions, cutover planning, and go-live stabilization.

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

• Must be available to work standard PST business hours, Monday–Friday, 8:00 AM–5:00 PM PST.

• A Master's degree (MBA, MPH, MHA, or MS in Information Systems) is preferred.

• Direct experience in leading IKA-to-QNXT platform migrations is preferred.

• Experience in driving AI-driven operational enhancements within healthcare claims environments is preferred.

🏝️ Benefits

• 100% remote work.

• Scheduled Monday–Friday, 8:00 AM–5:00 PM PST.

• This is a full-time position.