Delivery Manager – Claims Modernization

Role Overview

We are seeking a highly experienced Delivery manager who can serve as an execution leader within a large-scale healthcare modernization initiative. This role requires someone who goes beyond traditional Agile facilitation and can actively drive delivery outcomes, manage ambiguity, influence stakeholders, hold teams accountable, and ensure predictable execution across modernization workstreams.

The ideal candidate brings a blend of:

• Healthcare payer experience
• Claims and EDI expertise
• Large-scale modernization program leadership
• Strong delivery management capabilities
• Data-driven decision-making skills
• Executive stakeholder management
• Proven ability to drive teams to commitments and measurable outcomes

This individual must be comfortable operating in a highly ambiguous environment where future-state architecture, roadmap definition, prioritization, and transformation planning are still evolving.

Must Be

✅ Delivery Manager first

✅ Scrum Master second

✅ Assertive leader

✅ Metrics-driven

✅ Comfortable challenging teams and stakeholders

✅ Proven modernization experience

✅ Strong healthcare payer background

✅ Can operate in ambiguity

✅ Drives accountability and execution

Key Responsibilities

Delivery Ownership

• Drive predictable delivery across multiple modernization initiatives.
• Own delivery commitments, milestone tracking, dependency management, and execution governance.
• Establish delivery transparency through metrics, dashboards, and ongoing performance monitoring.
• Ensure commitments are achieved through proactive intervention and risk management.

Modernization Program Leadership

• Lead execution of healthcare platform modernization initiatives.
• Support transition from monolithic architectures toward modular, API-driven, or event-driven ecosystems.
• Coordinate business, product, architecture, engineering, operations, and vendor teams.
• Translate modernization roadmaps into executable plans and measurable outcomes.

Data-Driven Delivery Management

Use objective delivery indicators including:

• Sprint predictability
• Burndown trends
• Velocity analysis
• Throughput metrics
• Commitment reliability
• Defect leakage
• Dependency tracking
• Release readiness indicators
• Team performance metrics

Drive decisions based on data rather than assumptions.

Risk & Escalation Management

• Identify delivery risks early.
• Perform impact analysis across business, customer, operational, and technology dimensions.
• Escalate appropriately and decisively.
• Remove obstacles affecting delivery performance.
• Drive corrective actions when commitments are at risk.

Stakeholder Management

• Manage competing priorities across business and technology teams.
• Influence decision making using evidence and business impact analysis.
• Facilitate alignment among conflicting stakeholders.
• Communicate risks, tradeoffs, and recommendations clearly to leadership.

AI & Operational Enablement

• Drive operational improvement opportunities utilizing:
• Intelligent automation
• Workflow orchestration
• Monitoring platforms
• Analytics
• Operational insights
• AI-enabled productivity solutions

Focus must be on measurable business outcomes rather than AI for experimentation purposes.

Required Experience

Healthcare Domain (Mandatory)

10+ years of experience in Healthcare Payer organizations with deep understanding of:

• Claims processing
• Claims adjudication
• Eligibility
• Enrollment
• Provider workflows
• Member workflows
• Healthcare operations

Strong preference for candidates who have worked with:

• CVS/Aetna
• Elevance
• United Healthcare
• Humana
• Cigna
• Centene
• Molina

EDI Experience (Mandatory)

Hands-on experience with healthcare transaction processing including:

• 837 Claims
• 835 Remittance
• 270/271 Eligibility
• 276/277 Claim Status
• Enrollment transactions
• Reconciliation processes

Candidate should have participated in implementation, modernization, transformation, or operational delivery involving EDI solutions.

Modernization Experience (Mandatory)

Must have led delivery in at least one large modernization initiative involving:

• Legacy modernization
• Platform transformation
• Claims modernization
• Core administration modernization
• Architecture modernization
• Data modernization
• Cloud transformation

Preferred experience:

• Monolithic to modular architecture migration
• API enablement
• Event-driven architecture
• Real-time data services
• Platform decomposition

Delivery Management Experience (Critical Requirement)

The candidate must provide concrete examples of:

Team Performance Improvement

• Improved team velocity
• Increased predictability
• Reduced delivery slippage
• Improved release quality
• Accelerated delivery timelines

Measurable Business Impact

Must demonstrate:

• What problem existed
• What actions they personally took
• What decisions they influenced
• What the measurable outcome was

Candidates who provide only high-level examples should not be considered.

Leadership Competencies

Required

Assertiveness

Ability to:

• Challenge commitments
• Hold teams accountable
• Escalate difficult issues
• Push for decisions
• Drive actions to closure

Influence Without Authority

Proven ability to:

• Align cross-functional teams
• Manage resistant stakeholders
• Resolve competing priorities
• Gain executive support

Ambiguity Management

Ability to succeed when:

• Requirements are evolving
• Roadmaps are incomplete
• Organization is in discovery mode
• Priorities change rapidly

Technical & Tooling Experience

Required:

• Jira
• Confluence
• Agile metrics reporting
• Sprint governance
• Release planning
• Risk management tools

Strongly Preferred:

• Data visualization and dashboarding
• Power BI
• Modern SDLC practices
• DevOps exposure
• Cloud modernization environments