IS Development Claims Manager

  • Location: Portland
  • Type: Direct Hire
  • Job #878

Job Summary:
This position is responsible for managing cross functional software development teams comprised of a range of technical roles and responsibilities.  This position may be in charge of managing a team or teams which are focused in one or more of the areas such as Electronic Data Interchange (EDI), Web Development, Mobile Development, Architecture, Requirements Analysis, Quality Analysis, Technical Integration, etc.

 Essential Responsibilities:
Operational Planning and Oversight

  • Participates in long-term systems architecture planning.
  • Create systems architecture plans with focus on taking advantage of new cloud technologies, resolving challenges encountered today and to setting up system for scale to handle future volumes.
  • Develops 18-to-24-month roadmap for system improvements in consultation with appropriate stakeholders.
  • Plans and executes regular releases/upgrades as per agreed roadmap.
  • Implements changes to system to support enterprise project requirements.
  • Maintains visibility into vendor and partner roadmaps and appropriately adjust roadmaps, plans, and priorities to maintain low technical debt.
  • Develops resource and capacity plans for team’s direction and roadmaps.
  • Manages and oversees the operations and performance of all areas of responsibility to ensure organizational effectiveness.
  • Works collaboratively with other teams within ISBI to provide expertise, support, and capacity to solve larger cross team challenges, facilitate resolution of intermittent issues and support processes spanning multiple teams.
  • Develops and maintains strong relationships with stakeholders in other business units and peers in ISBI; collaborates effectively with these groups.
  • Creates consistency in IS development processes and communicates these clearly to IS and non-IS groups.
  • Communicates plans and intentions clearly to ISBI and Non-ISBI groups Incorporates best practices for design, architecture, development, and support.

Technical/Operational Leadership

  • Leads the execution of strategic initiatives, plans, and goals and contributes to organizational vision and goals.
  • Provides continuous evaluation of systems in support of scale, agility, and stability to meet existing and emergent organizational needs.
  • Establishes and maintains an implementation teams to implement near term and ongoing improvements to systems.
  • Leads innovation, process reviews, and improvement efforts; improves processes and procedures to ensure compliance with regulatory bodies and statutes, including HIPPA standards for PHI protection and transmission.
  • Refines business and systems requirements for new information technologies in support of application rationalization and modernization.
  • Maintains and enhance existing systems; discontinue systems no longer cost effective.
  • Lead teams in the building of application systems using a variety of software development tools including TSQL, SQL Server Integration Services, Visual Studio.Net and others.
  • Develops, monitors, and reports on KPIs, metrics and SLAs across the team.
  • Ensures compliance with internal auditing, HIPAA, and other federal regulations.
  • Promotes ISBI programs and staff achievements across the organization through regular and transparent reporting, as well as publishing workplans.
  • Provides operational leadership for ISBI teams by recommending, developing, and implementing third-party solutions.
  • Acts as project leader on complex software development programs.
  • Exercises sound business and technical judgement in making effective technical decisions for design and architecture of systems.
  • Ensures technical documentation is established and maintained for systems and related components and processes for technical focus area.

Project Management and Participation

  • Plans, organizes, manages, and monitors work projects.
  • Acts as project manager for projects related to system improvements for technical focus area.
  • Ensures project deliverables are met according to quality control schedules and standards.
  • Develops plans and processes to eliminate need for internal project management team’s engagement for routine operational projects such as releases, version upgrades, technology stack upgrade, etc.
  • Utilizes ServiceNow or similar tool for managing resources, work plans and commitments.
  • Performs business needs analysis and develops functional requirements for technical focus area as needed.

Relationship Management

  • Leads effective communication system for work groups, ensuring a collaborative culture.
  • Builds and ensures effective relationships across internal teams and external organizations for current or future integration.
  • Liaises between the IS Development teams, other IS groups and non-IS business partners.
  • Partners with internal leaders and managers to identify improvement plans and processes.
  • Partners with or leads other ISBI leaders in support of project management, release management, change management and incident management decisions and administration.
  • Develops and maintains knowledge of critical functions that support our members and patients; collaborates with stakeholders to understand informational requirements to support department goals.
  • Represents within and outside the organization, providing productive leadership presence and effectiveness.
  • Establishes and maintains cooperative and productive working relationships with internal and external customers.
  • Works collaboratively to resolve complex system problems and assist internal and external user departments as required.

Employee Supervision

  • Manages team(s) and recommends team direction and goals in alignment with the organizational mission, vision, and values.
  • Identifies work and staffing needs to meet work expectations; recruits and hires, using an equity, diversity, and inclusion lens.
  • Plans, organizes, schedules, and monitors work; ensures employees have information and resources to meet job expectations.
  • Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
  • Trains, supervises, motivates, and coaches employees; provides support toward employee development.
  • Incorporates guidance from equity tools into people leadership, planning, operations, evaluation, and decision making.
  • Ensures team adheres to department and organizational standards, policies, and procedures.
  • Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action). 
  • Performs supervisory tasks in collaboration with Human Resources as needed.

Experience and/or Education

  • Minimum 8 years’ relevant experience, including 3 years managing information services teams; experience should include recent experience in the following areas:
  • Leading cross functional teams with senior software developers, Database Administrators, Quality Analysts, and Application Administrators
  • Leading teams accountable for systems design, implementation, and support
  • Leading teams through the re-architecture of business-critical systems
  • Leading teams through cloud migration of business-critical systems
  • Leading change within team and across the enterprise
  • Leading and maturing a service organization in an environment of diverse stakeholders and dynamic priorities
  • Experience working in health care payer/managed care organizations
  • Establishing and managing follow the sun model for support and in utilizing onshore/offshore resources to successfully augment team capacity
  • Experience with Agile frameworks
  • Minimum 2 years’ experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of Aspiring Leaders Program
  • Bachelor’s degree in Information Services, or technology related field
  • For EDI focus:
    • Experience with MS Azure cloud specifically utilizing Logic Apps, containers, etc. for migrating use cases to cloud
    • Experience with migrating Biztalk to MS Azure Logic Apps or comparable solution
    • PMP or other project management training and experience in managing large projects

Eligibility requires:

  • Min 4+ Years of experience
  • Bachelor’s degree in Information Services or technology related field
  • Exp managing information services team
  • Experience with Claims
  • QNXT experience required.
  • Exp managing a mix of technical teams such as QA/ Developers, Architects, etc.
  • Must come from a Technical or Engineering background
  • Exp working in health care payer/managed care organizations
  • Leading teams through the re-architecture of business-critical systems
  • Leading teams through cloud migration of business-critical systems
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