Provider Data Remote Jobs in Orange, CA (NOW HIRING)

We are seeking an QNXT Program Manager to take full accountability for the Claims Workstream within a large-scale QNXT core platform transformation, including migrating from the current IKA platform.

Location: Long Beach, CA (100% Remote)

Schedule: Monday Friday, 8:00 AM 5:00 PM (PST)

Start Date: 08/10/2026

End Date: 02/10/2027

In this role, you will lead the end-to-end planning, execution, governance, and delivery of all claims-related implementation activities. You will collaborate closely with product managers and leaders supporting Provider Data, Configuration (provider contracts, benefits, utilization management, business rules), and Capitation to ensure a seamless migration, precise claims adjudication, and operational readiness for go-live.

• Program Leadership & Migration: Accountable for end-to-end implementation and issue resolution for the QNXT Claims workstream, driving the complete migration off the IKA platform.
• Integrated Planning & Governance: Manage the claims implementation plan across operations, configuration, testing, data conversion, training, cutover, and post-go-live stabilization. Maintain RAID logs, decision logs, and status reporting.
• Cross-Functional Workstream Alignment: Coordinate alignment across Claims, Provider Data, Benefits, Utilization Management, and Capitation to ensure accurate future-state claims adjudication, pricing, and payment.
• Vendor & Consultant Management: Direct day-to-day collaboration with external implementation consultants and software vendors to ensure scope, timelines, deliverables, and architecture decisions stay on track.
• Testing, Cutover & Stabilization: Lead preparations for system testing, defect triage, mock conversions, go-live cutover, and post-implementation stabilization while validating contingency and readiness plans.
• Risk & Change Management: Proactively identify execution risks, workflow gaps, and dependency issues to safeguard project timelines, claims accuracy, and stakeholder confidence.

• Education: Bachelor's degree in Business, Health Administration, Information Systems, or a related field (or equivalent combination of education and experience).
• Experience: Minimum 6 years of related experience within a health plan, managed care, or healthcare organization.
• Core Platform Expertise: Hands-on experience with QNXT (or a directly comparable core administrative platform) is required.
• Domain Knowledge: Deep expertise in healthcare payer claims operations and the end-to-end claims lifecycle (adjudication, pricing, payment, and provider/benefit configuration interactions).
• Transformation Leadership: Proven experience leading large, cross-functional system implementations or platform migrations involving data conversion, system testing, defect triage, mock conversions, cutover planning, and go-live stabilization.
• Technical Proficiency: Advanced skills with Microsoft Office Suite (Word, Excel, PowerPoint, Teams), Visio, Access, and SQL.
• Work Schedule: Ability to work standard PST business hours (Monday Friday, 8:00 AM 5:00 PM PST).

• Master's degree (MBA, MPH, MHA, or MS in Information Systems).
• Direct experience leading IKA-to-QNXT platform migrations.
• Experience driving AI-driven operational improvements within healthcare claims environments.

• Ability to take end-to-end ownership of a high-stakes, enterprise claims implementation with minimal supervision.
• Strong consensus-building and coaching skills to align senior leadership, technical teams, consultants, and vendors around common priorities.
• Comfort navigating fast-paced, complex, and ambiguous transformation environments.
• Sharp analytical, risk-management, and decision-making skills to resolve blockers before they impact critical path timelines.
• Exceptional executive-level communication and change-leadership abilities.