Job Description

Role: Technical Delivery Manager

Location: Remote

DG and Claims Modernization

Job Description:

Role Mandate: Delivery Manager first, pragmatic Agile leader second. Own day-to-day execution, drive accountability, and translate a complex modernization vision into predictable, measurable outcomes.

Position Summary:

• The Technical Delivery Manager leads end-to-end execution of the DG and claims modernization initiative across Aetna and Meritain Health. The role converts evolving priorities and architecture into integrated delivery plans, coordinates business and technology work streams, manages commitments and dependencies, and provides leadership with an accurate view of progress, risk, readiness, and delivery confidence.
• The successful candidate combines deep healthcare payer, claims, and EDI knowledge with strong technical delivery management, metrics-driven execution, stakeholder influence, and practical Agile leadership. The individual must be assertive, comfortable operating through ambiguity, and capable of challenging teams and stakeholders while fostering candid, constructive conversations that improve performance and accountability.

Core Leadership Profile:

• Delivery Manager first; Agile/Scrum leader second
• Assertive, execution-focused, and willing to challenge commitments
• Metrics-driven and able to convert delivery evidence into decisions
• Deep healthcare payer, claims, eligibility, enrollment, provider, and member workflow knowledge
• Hands-on healthcare EDI modernization experience
• Proven leadership of legacy, claims, platform, data, cloud, or architecture modernization
• Able to influence without authority in a highly matrixed environment
• Comfortable driving decisions when roadmaps, requirements, and target-state architecture are evolving

Key Responsibilities:

1. Delivery Leadership and Execution

• Convert approved priorities and modernization roadmaps into integrated delivery plans with milestones, owners, dates, dependencies, completion criteria, and measurable outcomes.
• Lead day-to-day execution across Product, Business, Engineering, Architecture, Operations, enterprise teams, vendors, consulting partners, and external delivery partners.
• Coordinate delivery from discovery and proof of concept through architecture, development, testing, release, operational transition, and benefits realization.
• Own commitments, milestone tracking, capacity, blockers, decisions, risks, issues, and cross-team dependencies through closure.
• Identify readiness gaps early, lead recovery planning, and escalate unresolved risks with clear impact analysis, options, recommendations, and required decisions.
• Work with Product Management to maintain practical Definition of Ready and Definition of Done standards.
• Promote transparency, accountability, follow-through, and continuous improvement without adding unnecessary process.

2. Healthcare Claims, EDI, and Modernization Delivery

• Lead execution of claims, core administration, legacy-platform, data, architecture, cloud, or enterprise-platform modernization initiatives.
• Coordinate modernization from monolithic applications toward modular, API-enabled, event-driven, real-time, or distributed ecosystems.
• Manage delivery involving claims processing and adjudication, eligibility, enrollment, provider workflows, member workflows, reconciliation, and healthcare operations.
• Lead or coordinate healthcare EDI implementation, modernization, transformation, or operations involving 837 Claims, 835 Remittance, 270/271 Eligibility, 276/277 Claim Status, enrollment transactions, acknowledgments, exception handling, and reconciliation processes.
• Facilitate decomposition of modernization scope into executable increments while preserving end-to-end business, data, integration, and operational dependencies.

3. Agile and Flow Management

• Apply pragmatic Agile, Scrum, Kanban, or hybrid methods based on the nature of the work rather than focusing only on ceremonies.
• Lead planning, refinement, reviews, retrospectives, dependency forums, release-readiness discussions, and other delivery cadences required for execution.
• Use objective delivery metrics such as sprint predictability, burndown, velocity, throughput, commitment reliability, cycle time, defect leakage, dependency aging, release readiness, and milestone confidence.
• Challenge low-confidence commitments, weak sequencing, unclear ownership, and unresolved dependencies; drive corrective actions to closure.
• Use capacity and operational data to forecast progress, expose constraints, and improve flow and delivery reliability.

4. Risk, Escalation, and Stakeholder Management

• Identify delivery risks early and assess impact across member, provider, operational, business, financial, compliance, and technology dimensions.
• Maintain strong RAID and decision governance; ensure owners, due dates, mitigation actions, and escalation paths are visible.
• Influence decisions using evidence, delivery data, business impact, tradeoffs, and clear recommendations.
• Facilitate alignment among competing stakeholders, resistant teams, and shifting priorities.
• Provide concise executive communications on completed outcomes, commitments at risk, delivery confidence, decisions needed, and support required.

5. Delivery Visibility, Reporting, AI, and Operational Enablement

• Maintain accurate delivery visibility through Jira, Confluence, integrated plans, dashboards, concise status reports, and leadership updates.
• Use data visualization and reporting to communicate trends, delivery health, dependencies, risks, quality, and readiness.
• Apply approved AI agents, reusable skills, prompts, intelligent automation, workflow orchestration, analytics, monitoring, and operational insights to improve planning, analysis, documentation, reporting, and team productivity.
• Ensure AI and automation use cases are tied to measurable business or delivery outcomes rather than experimentation alone.

Required Qualifications:

• 10+ years of experience in healthcare payer organizations with practical knowledge of claims, adjudication, eligibility, enrollment, provider workflows, member workflows, and payer operations.
• 7+ years in technical delivery, program management, software delivery, project management, Scrum leadership, or a related role; demonstrated ownership of complex multi-team delivery.
• Proven success leading at least one large modernization initiative involving legacy, claims, core administration, platform, architecture, data, cloud, or enterprise technology transformation.
• Hands-on experience delivering healthcare EDI solutions or operations involving 837, 835, 270/271, 276/277, enrollment, acknowledgments, exception handling, or reconciliation.
• Strong understanding of the software development lifecycle, including discovery, architecture, planning, development, testing, release, cutover, hypercare, and operational transition.
• Experience managing integrated plans, milestones, commitments, capacity, dependencies, risks, recovery actions, and release readiness.
• Ability to translate technical constraints and delivery evidence into clear forecasts, tradeoffs, decisions, and executive communications.
• Experience operating in highly matrixed and ambiguous environments with evolving requirements, roadmaps, priorities, and architecture.
• Proficiency with Jira, Confluence, Agile metrics, sprint governance, release planning, and risk-management practices.
• Working knowledge of approved AI productivity tools, agents, reusable skills, prompts, automation, or workflow optimization.
• Bachelor s degree or equivalent practical experience.

Preferred Qualifications:

• Direct experience with Aetna/CVS Health, Meritain Health, Elevance Health, UnitedHealthcare, Humana, Cigna, Centene, Molina, or another large payer.
• Experience with platform decomposition, API enablement, event-driven architecture, real-time data services, cloud transformation, or distributed systems.
• Familiarity with payer legacy applications, claims engines, EDI gateways, data platforms, business-rules engines, APIs, and operational processes.
• Experience coordinating vendors, consulting firms, clearinghouses, or external delivery partners.
• Practical DevOps, CI/CD, test automation, observability, release-readiness, dashboarding, or Power BI experience.
• Relevant delivery, program-management, Agile, Scrum, SAFe, cloud, or healthcare-domain certifications.

Required Evidence of Impact:

• Candidates must provide concrete examples, not high-level statements, demonstrating:
• The delivery or business problem that existed and why it mattered.
• The actions personally taken, including decisions influenced, conflicts resolved, escalations led, and teams held accountable.
• The metrics used to assess delivery health and guide intervention.
• Measurable outcomes such as improved predictability or velocity, reduced slippage, shorter lead time, better release quality, fewer EDI rejections, faster claims processing, higher automation, reduced operational effort, or improved readiness.

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