Medical Core System Transformation Lead Financial Services

1. Transformation Leadership

Lead the strategy, design and execution of the medical core system transformation program. Act as the single point of accountability for business outcomes, timeline and value realization. Translate enterprise strategy into a clear transformation roadmap, phased migration, MVPs, decommissioning.

Own transformation across key medical domains including Claims adjudication and payment

Policy benefits configuration

Provider and network management

Authorizations and utilization management

Medical pricing rules and payment logic. Drive modernization from monolithic legacy platforms to configurable API-driven core solutions.

Partner with Medical Operations Finance Actuarial Compliance and Provider Relations teams. Ensure business rules clinical workflows and regulatory requirements are accurately digitized. Resolve trade-offs between standard product capability vs local customization.

Lead engagement with core system vendors system integrators and niche solution providers. Oversee solution design deployment quality and contractual commitments. Govern vendor delivery to ensure alignment with architecture security and compliance standards.

Establish program governance including milestones dependencies and risks. Manage multi-workstream delivery technology data business readiness migration change. Ensure transformation is delivered with minimal disruption to ongoing business operations.

Ensure core systems meet health insurance regulatory payer and data privacy requirements. Support audits reporting and compliance validation through system design and controls.

Drive business adoption through process redesign training and change management. Define and track value realization metrics including speed cost accuracy scalability. Enable future capabilities such as analytics automation and AI-driven operations.

• 12+ years of experience in health insurance, payer operations, or healthcare technology.
• Proven leadership of large-scale core system transformation programs in medical insurance.
• Deep understanding of medical claims, benefits, pricing, provider networks, and utilization management.
• Experience modernizing legacy medical core platforms to modern or SaaS-based solutions.

• Strong knowledge of health insurance core systems (claims/PAS/medical modules).
• Experience with system migration, data conversion, and parallel run strategies.
• Understanding of API-based integration, interoperability, and data architecture.
• Comfort working with enterprise architects, security, and data teams.

• Strong stakeholder management across business, clinical, technology, and vendors.
• Ability to lead through ambiguity and make pragmatic trade-offs.
• Executive-level communication and decision facilitation skills.
• Outcome-oriented mindset with strong delivery discipline.

• Core medical system migration delivered on time and within agreed scope.
• Reduction in claims processing time, errors, and manual interventions.
• Improved configurability of medical benefits and pricing.
• Measurable improvement in member and provider experience.
• Safe decommissioning of legacy platforms and technical debt reduction.