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.

Desired Candidate Profile

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