Note: The job is a remote job and is open to candidates in USA. Impresiv Health is a healthcare consulting partner specializing in clinical and operations management, enterprise project management, professional services, and software consulting. The Program Lead, QNXT Implementation is responsible for the successful implementation of the Claims workstream within a large-scale QNXT core platform transformation, ensuring deliverables are completed accurately and on schedule.
Responsibilities
- Serve as the accountable program lead for the QNXT Claims implementation, with end-to-end responsibility for planning, execution, issue resolution, and successful migration from IKA
- Develop and manage the integrated claims implementation plan across business operations, configuration, data, testing, training, operational readiness, and cutover activities
- Establish clear milestones, deliverables, dependencies, accountable owners, and completion criteria
- Coordinate alignment across Claims, Provider Data, and Configuration workstreams, including provider contracts, benefits, utilization management and business rules, and capitation
- Ensure the future-state solution supports accurate claims adjudication, pricing, payment, and issue resolution
- Partner with future-state designers, internal subject matter experts, technology teams, product managers, implementation consultants, and vendors
- Translate future-state workflows and strategic objectives into clear business requirements, operating model changes, implementation priorities, and executable plans
- Own claims implementation governance, including status reporting, RAID logs, decision logs, escalation management, and stakeholder communications
- Ensure claims-related deliverables are accurate, complete, and traceable, including requirements, process designs, configuration inputs, data-conversion needs, test scenarios, defect-resolution plans, readiness criteria, and go-live support materials
- Coach and coordinate program managers, operational leaders, and subject matter experts by establishing clear ownership and driving accountability for commitments and outcomes
- Manage daily collaboration with implementation consultants and vendors to ensure scope, timelines, deliverables, and design decisions align with business objectives and enterprise governance standards
- Lead preparation for system testing, defect triage, mock conversions, operational readiness, cutover, go-live, and post-implementation stabilization
- Validate defect-remediation plans, operational contingency plans, and readiness criteria before implementation milestones are approved
- Identify execution risks, workflow gaps, and dependency failures early and implement corrective actions that protect the timeline, quality, claims accuracy, and stakeholder confidence
- Support SCAN’s vision and organizational goals while exploring how AI can improve operations and service delivery
- Perform other duties as assigned
Skills
- Bachelor's degree in Business, Health Administration, Information Systems, or a related field, or an equivalent combination of education and relevant experience
- At least six years of related experience within a health plan, healthcare organization, or related industry
- Strong knowledge of healthcare payer claims operations and the end-to-end claims lifecycle
- Experience leading large, cross-functional system implementations or business transformations involving claims, operations, configuration, data, testing, and operational readiness
- Working knowledge of QNXT or a comparable core administrative platform
- Understanding of how claims processing interacts with provider data, benefits, provider contracts, utilization management and business rules, capitation, and other upstream and downstream functions
- Experience with business requirements, process design, data conversion, system testing, defect triage, mock conversions, cutover planning, go-live readiness, and post-launch stabilization
- Experience managing implementation consultants, vendors, product managers, subject matter experts, and cross-functional project teams
- Strong facilitation, communication, coaching, influencing, and stakeholder-management skills
- Strong analytical, problem-solving, risk-management, and decision-making abilities
- Demonstrated experience driving accountability and team performance in complex transformation programs
- Advanced proficiency with Microsoft Word, Excel, PowerPoint, Outlook, Teams, Access, Visio, and SQL
- Master's degree in Business Administration, Public Health, Health Administration, Information Systems, or a related field preferred
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