Medical Core System Transformation Lead Financial Services Orient Insurance PJSC

Job description

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Description:

The Medical Core System Transformation Lead is responsible for end‑to‑end delivery of the health insurer’s core medical system modernization
, including policy administration, claims, benefits, provider management, and clinical integrations.

This role owns the business-led transformation of legacy medical systems into a modern, scalable, compliant, and digital-first platform that enables operational efficiency, better member and provider experience, regulatory compliance, and future AI/analytics capabilities.

What you will do

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.

Required Skills to be successful

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