Medical Core System Transformation Lead Financial Services
Listed on 2026-09-29
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IT/Tech
Change Management, Business Systems & Technology Analysis -
Business
Change Management, Business Systems & Technology Analysis
- 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).
- 2. Core Medical Systems Ownership
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.
- 3. Business & Clinical Alignment
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.
- 4. Vendor & Partner Management
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.
- 5. Governance & Delivery Execution
Establish strong 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.
- 6. Regulatory & Compliance Readiness
Ensure core systems meet health insurance regulatory, payer, and data privacy requirements
.Support audits, reporting, and compliance validation through system design and controls.
- 7. Change, Adoption & Value Realization
Drive business adoption through process redesign, training, and change management
.Define and track value realization metrics (speed, cost, accuracy, scalability).
Enable future capabilities such as analytics, automation, and AI-driven operations.
- Essential Experience
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.
- Technical & Domain Expertise
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.
- Leadership & Ways of Working
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.
- What equips you for the role
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
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