Technical Delivery Manager with Claims EXP

 

• 10+ years of experience in healthcare payer organizations with practical knowledge of claims, adjudication, eligibility, enrollment, provider workflows, member workflows, and payer operations.

• 7+ years in technical delivery, program management, software delivery, project management, Scrum leadership, or a related role; demonstrated ownership of complex multi-team delivery.

• Proven success leading at least one large modernization initiative involving legacy, claims, core administration, platform, architecture, data, cloud, or enterprise technology transformation.

• Hands-on experience delivering healthcare EDI solutions or operations involving 837, 835, 270/271, 276/277, enrollment, acknowledgments, exception handling, or reconciliation.

• Strong understanding of the software development lifecycle, including discovery, architecture, planning, development, testing, release, cutover, hypercare, and operational transition.

• Experience managing integrated plans, milestones, commitments, capacity, dependencies, risks, recovery actions, and release readiness.

• Ability to translate technical constraints and delivery evidence into clear forecasts, tradeoffs, decisions, and executive communications.

• Experience operating in highly matrixed and ambiguous environments with evolving requirements, roadmaps, priorities, and architecture.

• Proficiency with Jira, Confluence, Agile metrics, sprint governance, release planning, and risk-management practices.

• Working knowledge of approved AI productivity tools, agents, reusable skills, prompts, automation, or workflow optimization.

• Bachelor’s degree or equivalent practical experience.

 

• Direct experience with Aetna/CVS Health, Meritain Health, Elevance Health, UnitedHealthcare, Humana, Cigna, Centene, Molina, or another large payer.

• Experience with platform decomposition, API enablement, event-driven architecture, real-time data services, cloud transformation, or distributed systems.

• Familiarity with payer legacy applications, claims engines, EDI gateways, data platforms, business-rules engines, APIs, and operational processes.

• Experience coordinating vendors, consulting firms, clearinghouses, or external delivery partners.

• Practical DevOps, CI/CD, test automation, observability, release-readiness, dashboarding, or Power BI experience.

• Relevant delivery, program-management, Agile, Scrum, SAFe, cloud, or healthcare-domain certifications.

Required Evidence of Impact

Candidates must provide concrete examples, not high-level statements, demonstrating:

• The delivery or business problem that existed and why it mattered.

• The actions personally taken, including decisions influenced, conflicts resolved, escalations led, and teams held accountable.

• The metrics used to assess delivery health and guide intervention.

• Measurable outcomes such as improved predictability or velocity, reduced slippage, shorter lead time, better release quality, fewer EDI rejections, faster claims processing, higher automation, reduced operational effort, or improved readiness.