QNXT Program Manager

We are seeking a Program Lead for QNXT Claims Implementation to own the end-to-end delivery of the Claims workstream as we migrate from our current IKA platform.

You will serve as the primary accountable leader for planning, execution, and governance. You’ll bridge the gap between complex technical requirements and operational reality, ensuring our future-state solution supports accurate adjudication, pricing, and payment. If you thrive in fast-paced, ambiguous environments and can align cross-functional teams toward a successful go-live, we want to hear from you.

• Own the Implementation: Act as the accountable leader for the Claims workstream, from initial planning and migration to post-live stabilization.
• Drive Strategy & Execution: Translate future-state workflows into actionable business requirements and integrated workplans.
• Govern the Program: Manage RAID logs, decision logs, status reporting, and executive-level escalations.
• Coordinate Cross-Functionally: Lead alignment across Claims, Provider Data, and Configuration (contracts, benefits, UM, business rules, and capitation).
• Manage Partnerships: Direct daily collaboration with implementation consultants, vendors, and internal SMEs to ensure scope, timeline, and quality alignment.
• Lead Through Milestones: Oversee system testing, defect triage, mock conversions, operational readiness, and the final cutover.
• Innovate: Support organizational goals by identifying opportunities to leverage AI to improve claims operations and service delivery.

• Experience: 6+ years of experience in a health plan or healthcare organization.
• Platform Expertise:
  Hands-on experience with QNXT is required. (Comparable core administrative platform experience will be considered, but QNXT proficiency is mandatory).
• Domain Knowledge: Deep understanding of the end-to-end healthcare payer claims lifecycle and its interaction with upstream/downstream functions.
• Leadership: Proven ability to manage large-scale, cross-functional system implementations or business transformations.
• Technical Literacy: Advanced proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Teams, Access, Visio) and SQL.
• Education: Bachelor’s degree in Business, Health Administration, IS, or related field required;
  Master’s degree (MBA, MHA, MPH) preferred.

• You can maintain accountability in a high-stakes, fast-paced environment where information is often incomplete.
• You are a master of stakeholder management, capable of influencing senior leaders and coaching SMEs to drive performance.
• You possess a "builder’s mindset"—you don't just report on risks; you identify them early, resolve blockers, and implement corrective actions.
• You balance the "big picture" of long-term transformation with the "day-to-day" requirements of operational stability.

This is a critical role that will directly influence our ability to scale and serve our members. As a remote Program Lead, you will have the autonomy to drive change while collaborating with a high-performing team of experts.