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Program Manager
Location
California
Posted
7 days ago
Salary
0
Seniority
Senior
Job Description
Program Manager
HJ Staffing
• Lead the end-to-end planning, execution, governance, and delivery of all claims-related implementation activities • Collaborate closely with product managers and leaders supporting Provider Data, Configuration (provider contracts, benefits, utilization management, business rules), and Capitation to ensure a seamless migration, precise claims adjudication, and operational readiness for go-live • Accountable for end-to-end implementation and issue resolution for the QNXT Claims workstream, driving the complete migration off the IKA platform • Manage the claims implementation plan across operations, configuration, testing, data conversion, training, cutover, and post-go-live stabilization • Maintain RAID logs, decision logs, and status reporting • Coordinate alignment across Claims, Provider Data, Benefits, Utilization Management, and Capitation to ensure accurate future-state claims adjudication, pricing, and payment • Direct day-to-day collaboration with external implementation consultants and software vendors to ensure scope, timelines, deliverables, and architecture decisions stay on track • Lead preparations for system testing, defect triage, mock conversions, go-live cutover, and post-implementation stabilization while validating contingency and readiness plans • Proactively identify execution risks, workflow gaps, and dependency issues to safeguard project timelines, claims accuracy, and stakeholder confidence
Job Requirements
- Bachelor’s degree in Business, Health Administration, Information Systems, or a related field (or equivalent combination of education and experience)
- Minimum 6 years of related experience within a health plan, managed care, or healthcare organization
- Hands-on experience with QNXT (or a directly comparable core administrative platform) is required
- Deep expertise in healthcare payer claims operations and the end-to-end claims lifecycle (adjudication, pricing, payment, and provider/benefit configuration interactions)
- Proven experience leading large, cross-functional system implementations or platform migrations involving data conversion, system testing, defect triage, mock conversions, cutover planning, and go-live stabilization
- Advanced skills with Microsoft Office Suite (Word, Excel, PowerPoint, Teams), Visio, Access, and SQL
- Ability to work standard PST business hours (Monday – Friday, 8:00 AM – 5:00 PM PST)
Benefits
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options
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