Director, Claims Systems and Electronic Data Interchange

Impresiv Health•Longwood, FL

3d•Remote

About The Position

Impresiv Health is seeking an experienced Director, Claims Systems and Electronic Data Interchange (EDI) to lead the development, execution, operational performance, and ongoing maintenance of mission-critical healthcare claims processing and EDI systems. The role is responsible for the stability, scalability, and reliability of claims processing environments across multiple lines of business. The Director oversees Claims and EDI operations, drives system improvements, supports modernization initiatives, and collaborates with cross-functional stakeholders to ensure technology solutions meet evolving business and operational needs. The ideal candidate has extensive healthcare claims systems experience, particularly with QNXT, as well as technical leadership, systems implementation, and EDI expertise within a managed care environment. The Director leads Claims and EDI teams, including managers and supervisors, and oversees internally developed and third-party applications that support claims processing and EDI operations. The position is remote, with availability to work Pacific Time Zone (PST) hours required. It reports to the VP IS Analytics and Development and is in the Information Systems department.

Requirements

Bachelor's degree in Information Systems, Business, Healthcare, or a related field.
At least 10 years of relevant professional experience in information systems, healthcare technology, claims processing, or related functions.
At least 5 years of experience managing information services teams, including managers, supervisors, or technical professionals.
Strong knowledge of QNXT claims processing systems and EDI platforms, including their integration with healthcare business operations.
Demonstrated experience leading Claims and EDI teams or organizations.
Experience managing application development, technical support, and vendor management teams.
Experience supporting the re-architecture or significant transformation of business-critical systems.
Experience leading enterprise-level change initiatives and complex technology implementations.
Experience managing service-oriented organizations with diverse stakeholders and evolving business priorities.
Strong technical problem-solving, organizational leadership, and stakeholder communication skills.
Ability to lead technical teams responsible for complex, business-critical healthcare applications.
Ability to translate complex technical challenges into practical solutions that support business operations.
Excellent communication skills, including the ability to present complex technical information to staff, senior leadership, and executive stakeholders.
Ability to manage competing priorities while maintaining standards for system performance, reliability, and service delivery.
Must be available to work Pacific Time Zone (PST) hours.

Nice To Haves

Hands-on leadership experience with QNXT system implementations, upgrades, or enhancements.
Experience with Microsoft Azure and Azure Logic Apps, particularly for EDI integration and modernization.
Familiarity with IT Service Management (ITSM) and IT Infrastructure Library (ITIL) frameworks.
Experience working with Electronic Health Record (EHR) systems.
Healthcare payer or managed care industry experience.
Knowledge of Medicaid, Medicare, and managed care operations.

Responsibilities

Lead the development, implementation, support, and ongoing maintenance of enterprise Claims and EDI systems across multiple lines of business.
Oversee the operational performance, stability, scalability, and reliability of mission-critical claims processing environments.
Direct the maintenance, upgrades, enhancements, expansions, architecture, and modernization of Claims and EDI platforms.
Establish and lead a dedicated Claims System Implementation Team to support system initiatives and operational priorities.
Execute strategic technology initiatives and implementation plans aligned with organizational objectives.
Develop and implement modernization strategies to reduce operational risk, improve system maintainability, and enhance performance.
Oversee internally developed and third-party applications essential to claims processing and EDI operations.
Partner with business and technology leaders to identify operational needs, address system challenges, and deliver solutions.
Lead managers, supervisors, and technical teams responsible for claims systems development, support, and operational execution.
Evaluate systems and processes to identify opportunities to improve efficiency, agility, and long-term sustainability.