Job Description
Job Summary: Lead technical delivery of projects that design, build, integrate, and maintain systems for medical claims processing. Act as the bridge between business stakeholders (claims operations, clinical reviewers, finance, compliance) and engineering/IT teams to deliver scalable, compliant, and timely solutions that improve claims accuracy, throughput, and reporting.
Key Responsibilities:
Lead end-to-end project lifecycle: scope, planning, budgeting, resource allocation, risk management, delivery, and post-implementation review.
Translate business requirements (claims adjudication rules, payment integrity, denials management, appeals workflows, provider and member data needs) into technical specifications and user stories.
Coordinate cross-functional teams: software engineers, QA, data engineers, BI, integration specialists, vendors, product owners, and clinical SMEs.
Oversee integrations with core claims systems, EDI (8...