Note: The job is a remote job and is open to candidates in USA. UST is a technology services company that delivers innovative, human-centered solutions for clients and partners. The Healthcare Program Director will lead the end-to-end delivery, governance, operational excellence, financial performance, and strategic growth of an Administrative Platform services initiative supporting the HealthRules Payer ecosystem. The role oversees service delivery, compliance, risk management, operational metrics, client governance, and implementation activities.
Responsibilities
- Own the overall service delivery strategy for the Administrative Platform engagement and align delivery objectives to the client’s business outcomes, operational goals, and technology roadmap
- Lead Executive Steering Committee, Quarterly Business Reviews, Monthly Service Reviews, and Operational Governance forums
- Lead the contract deliverables to ensure all commitments are met
- Provide executive oversight for all in-scope services including: + HealthRules Payer platform services + Enrollment processing support + Claims platform operations + Reporting services + Overarching Implementation program manager with numerous partners and dependencies + Deliverables from client accountability + Command Center Support + Release and environment management activities
- Establish governance mechanisms to ensure SLA/KPI compliance, service availability, delivery predictability, and operational excellence
- Drive adherence to Incident, Problem, Change, Release, Contract change, and Knowledge Management processes
- Ensure successful delivery of all aspects of the program for each deliverable
- Oversee major incident management, SWAT calls, RCA reviews, and corrective action implementation
- Drive operational metrics including SLA and KPI adoption
- Ensure readiness and support for annual enrollment cycles, platform upgrades, releases, and disaster recovery exercises
- Report on contractual SLAs and KPIs
- Track and report Implementation Criteria
- Lead service recovery initiatives and governance reviews for SLA breaches
- Present monthly SLA performance, operational metrics, and executive dashboards to client leadership
- Manage subcontractor relationships to contract commitments
- Support contract governance, change requests, business case development, and commercial discussions
- Lead enterprise risk management and mitigation activities
- Ensure compliance with: + HITRUST requirements + HIPAA regulations + Security standards + Audit requirements + Disaster Recovery and Business Continuity obligations + Contract commitments
- Sponsor periodic security reviews, vulnerability assessments, DR testing, and compliance audits
- Govern offshore delivery compliance and data access controls in alignment with contractual requirements
Skills
- • At least 20 years in the HealthRules Payer Ecosystem
- • Healthcare Payer Administration Platforms experience
- • Claims Adjudication and Enrollment Processing
- • EDI Transactions (834, 837, 835, 270/271)
- • Data Integration and Operational Reporting experience
- • HIPAA, HITRUST, and Healthcare Compliance
- • Large Scale Managed Services and Platform Operations experience
Benefits
- Full-time, regular employees accrue a minimum of 10 days of paid vacation per year
- Full-time, regular employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year)
- Full-time, regular employees receive 10 paid holidays
- Full-time, regular employees are eligible for paid bereavement leave and jury duty
- Full-time, regular employees are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching
- Full-time, regular employees and their dependents residing in the US are eligible for medical, dental, and vision insurance
- Full-time, regular employees receive Company-paid basic life insurance
- Full-time, regular employees receive Company-paid accidental death and disability insurance
- Full-time, regular employees receive Company-paid short- and long-term disability benefits
- Regular employees may purchase additional voluntary short-term disability benefits
- Regular employees may participate in a Health Savings Account (HSA)
- Regular employees may participate in a Flexible Spending Account (FSA) for healthcare, dependent childcare, and/or commuting expenses as allowable under IRS guidelines
- Benefits offerings vary in Puerto Rico
- Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year)
- Part-time employees are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching
- Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year)
- Full-time temporary employees are eligible to participate in the Company’s 401(k) program with employer matching
- Full-time temporary employees and their dependents residing in the US are eligible for medical, dental, and vision insurance
- Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year)
- All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws
Company Overview
Company H1B Sponsorship