Responsibilities

Position OverviewPeraton is seeking an experienced Technical Project Manager to support the CMS ClaimsCore modernization program. The successful candidate will combine strong technical program leadership with deep systemsintegration experience and practical knowledge of Medicare claims processing, shared services, beneficiary data, eligibility, interfaces, and data migration.

This individual will provide technical leadership across ClaimsCore integration, migration, interface planning, and claimsprocessing activities as the program transitions from Proof of Concept (PoC) into production implementation. The role operates at the intersection of Medicare business operations, claims adjudication, systems engineering, data flows, interfaces, and program execution.

The candidate must be technically conversant and able to translate complex Medicare operational and technical requirementsincluding beneficiary/eligibility dependencies, provider data, historical claims information, and EDI/X12 transaction flowsinto executable plans. The TPM will coordinate teams across Peraton, CMS, MACs, Cognizant/Facets, federal partners, and supporting vendors, ensuring alignment across integration, testing, cutover, and productionreadiness activities.

The TPM is expected to identify crosssystem dependencies, resolve technical issues and integration blockers, support interface discovery and specification development, and lead production workstream execution through implementation waves, cutover, onboarding, and stabilization.

Key ResponsibilitiesLead complex technical initiatives involving systems integration, data migration, claimsprocessing capabilities, and Medicare shared services.Develop and manage integrated implementation plans covering interfaces, data flows, configuration, testing, operational readiness, and production transition.Coordinate technical activities across application development, integration, infrastructure, security, data, testing, and business teams.Lead interface discovery and planning activities, including currentstate analysis, requirements, ICD/spec development, testing, certification, cutover, and production readiness.Work with CMS, MACs, and SMEs to understand beneficiary, eligibility, provider, claims history, claimstatus, adjudication, and pricing/editing dependencies.Lead complex datamigration activities including sourcesystem analysis, mapping, transformation, reconciliation, historicaldata use, data quality, and migration validation.Ensure migration/integration designs incorporate historical claims information, accumulators, beneficiary/eligibility attributes, and provider data required to process future claims.Coordinate implementation planning with ClaimsCore adjudication services and CMS shared services (e.g., CWF, PECOS, HIGLAS, pricing/editing services).Drive resolution of crossteam dependencies, technical issues, architectural decisions, risks, and implementation blockers.Develop executivelevel status updates, recommendations, risk assessments, and implementationreadiness materials.Support production planning including MAC onboarding, phased implementation waves, cutover, operational readiness, and stabilization.Define measurable entry/exit criteria and completion evidence for major implementation milestones.Facilitate technical working sessions with CMS, MACs, vendors, and engineering teams, translating discussions into clear decisions and accountable actions.Provide leadership to multidisciplinary teams and assume responsibility for a major ClaimsCore production workstream.

Qualifications

Required Qualifications

• Bachelors degree in IT, Computer Science, Engineering, Healthcare
• Administration, Business, or related field; equivalent relevant experience considered.
• 12+ years of progressively responsible technical project/program management experience in enterprise systems implementation.
• Demonstrated experience leading largescale systemsintegration initiatives involving APIs, EDI, batch/file, database, or multisystem connectivity.
• Demonstrated experience leading or coordinating large data migrations involving missioncritical systems.
• Healthcare payer or claimsprocessing experience, preferably with institutional and professional claims.
• Strong understanding of enterprise architectures, interfaces,
• ICDs/specifications, system dependencies, integration testing, and production cutover.
• Experience with interface inventories, dependency mapping, sourcetotarget data mapping, errorhandling approaches, reconciliation, and operational support models.
• Experience managing multidisciplinary technical teams and coordinating with infrastructure, application, business, and vendor stakeholders.
• Experience developing integrated schedules, risk registers, dependency matrices, and executivelevel reporting.
• Ability to communicate effectively with engineers, architects, SMEs, executives, government customers, and external partners.
• Ability to lead teams through ambiguity and develop actionable plans when requirements are evolving.
• Ability to obtain a Public Trust.
• US Citizen or a Green Card Holder.

Highly Preferred Qualifications

• Experience working with Medicare Administrative Contractors and understanding MAC operational dependencies.
• Direct CMS or Medicare FeeforService experience.
• Knowledge of CMS shared services such as CWF, PECOS, HIGLAS, pricing/editing services, eligibility/beneficiary services, claimstatus services, and related interfaces.
• Experience with TriZetto Facets integrations or implementations.
• Experience migrating from legacy claimsprocessing systems to modern platforms, including interface transition and production cutover.
• Experience with X12 healthcare transactions including 837, 835, 270/271, and 276/277.
• Experience with APIled, hybridcloud, or AWSbased integration architectures.
• Experience supporting or leading production deployments, phased migrations, MAC onboarding, and postimplementation stabilization.
• PMP, SAFe, Agile, or similar programmanagement certification.
• Experience in large federal healthcare modernization programs.

Target Salary Range$135,000 - $216,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individuals experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.