Description:The Program Lead, QNXT Implementation is accountable for the successful implementation of the Claims workstream within a large-scale QNXT core platform transformation, including migration from the current IKA platform. This role leads the end-to-end planning, execution, governance, and delivery of all claims-related implementation activities. The Program Lead will collaborate closely with product managers supporting Claims, Provider Data, and Configuration, including provider contracts, benefits, utilization management and business rules, and capitation. The ideal candidate brings strong healthcare payer claims expertise, QNXT or comparable core administrative platform experience, and a proven ability to lead complex, cross-functional implementations. This individual will ensure deliverables are completed accurately and on schedule, risks and dependencies are actively managed, teams remain aligned and accountable, and the organization is prepared for testing, cutover, go-live, and stabilization.
What You Will Do: - 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.
You Will Be Successful If: - You can take full ownership of a complex claims implementation and maintain accountability from planning through go-live stabilization.
- You understand the healthcare payer claims lifecycle and the operational and system components required for accurate adjudication, pricing, payment, and issue resolution.
- You can align senior leaders, operational teams, subject matter experts, technology partners, consultants, and vendors around common priorities and timelines.
- You can build and maintain integrated workplans, RAID logs, decision logs, governance routines, and executive-level status reporting.
- You can translate strategy and future-state designs into clear requirements, priorities, owners, and actionable implementation plans.
- You are comfortable leading in a fast-paced, ambiguous, and high-stakes transformation environment.
- You can identify risks, evaluate tradeoffs, resolve blockers, and make sound decisions when information is incomplete.
- You balance long-term transformation objectives with day-to-day operational realities.
- You drive disciplined execution while coaching teams, improving performance, and holding stakeholders accountable.
- You demonstrate strong program leadership, strategic planning, executive communication, stakeholder management, risk management, and organizational change leadership.
What You Will Bring: - Bachelor's degree in Business, Health Administration, Information Systems, or a related field, or an equivalent combination of education and relevant experience.
- Master's degree in Business Administration, Public Health, Health Administration, Information Systems, or a related field preferred.
- 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.
