Client Solution Executive

Tegria • Massachusetts, MA

2d • Remote

About The Position

The Executive Solution Executive serves as the senior client-facing leader responsible for driving strategic solution development, executive stakeholder alignment, and successful delivery oversight for the ClaimsCore Enterprise Program Management Office (EPMO) and related healthcare transformation initiatives. This role bridges business strategy, healthcare operations, claims administration, enterprise architecture, and program governance to ensure successful modernization of claims platforms and supporting business processes.
The Executive Solution Executive partners with Client leadership, technology teams, operations stakeholders, and platform vendors to establish program direction, mitigate risk, ensure claims accuracy, and drive measurable business outcomes across complex healthcare transformation efforts. The role provides executive oversight for dual-platform operations, enterprise PMO governance, change management, solution engineering, and advisory services.

Requirements

• Bachelor's degree in Healthcare Administration, Information Systems, Business Administration, Computer Science, or related field.
• 15+ years of healthcare payer, managed care, government healthcare, or healthcare technology experience.
• 10+ years leading large-scale business transformation, PMO, or modernization programs.
• Demonstrated experience supporting complex healthcare payer organizations or government healthcare programs.
• Deep understanding of claims administration, payment integrity, operations, and healthcare technology ecosystems.
• Experience leading executive governance, stakeholder management, and enterprise-level program delivery.
• Strong knowledge of enterprise architecture, systems integration, and digital transformation.
• Proven ability to manage complex, multi-vendor engagements.

Nice To Haves

• Experience with HealthEdge, Facets, or other core administration platforms.
• PMP, PgMP, Lean Six Sigma, TOGAF, SAFe, or equivalent certifications.
• Experience supporting Medicare, Medicaid, Commercial, or Government Programs.
• Background in enterprise transformation consulting, advisory services, or executive program leadership.
• Experience establishing or leading Enterprise PMOs.

Responsibilities

• Serve as the executive advisor to Client leadership on claims platform modernization and enterprise transformation initiatives.
• Lead strategic planning sessions and define program objectives, success criteria, and value realization strategies.
• Develop executive communications, steering committee presentations, and program status updates.
• Build trusted relationships with senior client stakeholders and vendor leadership teams.
• Provide thought leadership on healthcare payer operations, claims processing, and modernization best practices.
• Establish and oversee PMO governance frameworks including: Program planning and scheduling, RAID management (Risks, Assumptions, Issues, Dependencies), Stage-gate reviews, Executive reporting, Compliance and risk management.
• Ensure program alignment with strategic objectives and operational priorities.
• Lead cross-functional teams to drive accountability and execution excellence.
• Oversee technical solution strategy for ClaimsCore initiatives.
• Guide architecture decisions supporting dual-platform claims processing environments.
• Collaborate with enterprise architects, solution engineers, and technical SMEs to define scalable and sustainable solutions.
• Ensure integration of data, reporting, and operational performance capabilities.
• Evaluate solution alternatives and recommend optimal approaches balancing cost, risk, and business value.
• Provide executive oversight for claims adjudication validation and payment accuracy initiatives.
• Drive operational processes that support parity testing and quality assurance across multiple claims platforms.
• Collaborate with business and technical teams to identify process improvements and operational efficiencies.
• Ensure compliance with contractual, regulatory, and client-specific requirements.
• Lead business and technology alignment efforts across Facets, HealthEdge, and supporting enterprise systems.
• Facilitate integration planning, process harmonization, and organizational readiness activities.
• Partner with platform consultants and business leaders to optimize workflows and operational models.
• Support future-state design and implementation planning.
• Champion stakeholder engagement and executive sponsorship strategies.
• Oversee organizational readiness assessments and adoption planning.
• Ensure effective communication and change enablement activities across impacted organizations.
• Guide leadership teams through transformational change initiatives.
• Provide executive consulting support for emerging initiatives and strategic opportunities.
• Evaluate operational, technology, and business challenges and recommend actionable solutions.
• Identify opportunities to improve performance, reduce risk, and accelerate modernization efforts.
• Support business development, growth initiatives, and solution pursuits through strategic leadership.

Benefits

• Choice of multiple health and dental plans with nationally recognized networks
• Vision benefits
• Total wellness program
• Employee assistance program
• Competitive wages
• Retirement savings plans
• Company-paid disability and life insurance
• Pre-tax savings opportunities (HSA and/or FSA)
• Professional development offerings
• Opportunities for remote work
• Generous paid-time-off program

What This Job Offers

• Job Type: Full-time
• Career Level: Executive