Program Lead, QNXT Implementation - SCAN Temp

SCAN Health Insurance • Long Beach, CA

3d • $51 - $74 • Remote

About The Position

The Program Lead, QNXT Implementation - SCAN Temp is the accountable leader for successful implementation of the Claims workstream within the QNXT core platform transformation, including migration from the current IKA platform. This role directs end-to-end planning, execution, governance, and delivery across claims-related workstreams and coordinates closely with supporting product managers for Claims, Provider Data, and Configuration (including provider contracts, benefits, UM/business rules, and capitation), future state design, internal subject matter experts, and external consultants. The role is responsible for ensuring all deliverables are completed with quality and on schedule, risks and dependencies are actively managed, teams are coached and aligned, and the organization is operationally ready for testing, cutover, and go-live.

Requirements

• Bachelor’s degree or equivalent combination of education and experience - Business, Health Administration, Information Systems, or related fields.
• Minimum 6 years related experience with in the health plan, healthcare, or related industry.
• Strong knowledge of healthcare payer claims operations, end-to-end claims lifecycle, and business processes required to support accurate adjudication, pricing, payment, and issue resolution.
• Experience leading large, cross-functional system implementations or business transformations involving claims, operations, configuration, data, testing, and operational readiness.
• Working knowledge of QNXT or comparable core administrative platforms, including the relationship between claims processing and upstream/downstream functions such as provider data, benefits, contracts, UM/business rules, and capitation.
• Ability to build and manage integrated workplans, deliverables, RAID logs, decision logs, and governance routines in a complex program environment.
• Ability to translate strategy and future state design into clear business requirements, implementation priorities, accountable owners, and executable plans.
• Strong facilitation, communication, and influencing skills, with the ability to align senior leaders, SMEs, operational teams, and consultants around decisions, priorities, and timelines.
• Demonstrated ability to coach teams, drive accountability, and elevate performance in fast-paced, ambiguous, and high-stakes transformation environments.
• Strong analytical and problem-solving skills, including the ability to assess risks, surface tradeoffs, resolve blockers, and make sound decisions with incomplete information.
• Experience supporting implementation testing, defect triage, operational readiness, cutover planning, and go-live stabilization for major platform transitions.
• Ability to balance strategic transformation goals with day-to-day operational realities to deliver a stable, controlled, and business-ready migration from IKA to QNXT.
• Program leadership and accountability.
• Strategic planning and execution discipline.
• Cross-functional collaboration and influence.
• Executive communication and stakeholder management.
• Coaching, team leadership, and talent development.
• Risk management and decision making.
• Change leadership and organizational readiness.
• Consultant and vendor management.
• Operational excellence and results orientation.
• Advanced Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, Access), Visio, and SQL required.

Nice To Haves

• Master’s degree - MBA, MPH, MS in Health Administration, Information Systems, or related field.

Responsibilities

• Serve as the accountable program lead for the Claims implementation of QNXT, with end-to-end responsibility for planning, execution, issue resolution, and successful delivery of the claims migration from IKA.
• Lead the integrated claims implementation plan across business, operational, configuration, data, testing, training, readiness, and cutover activities; ensure milestones, deliverables, and dependencies are clearly defined, monitored, and achieved.
• Coordinate and drive alignment across supporting workstreams, including Claims, Provider Data, and Configuration for provider contracts, benefits, UM/business rules, and capitation, to ensure an end-to-end solution that supports accurate claim adjudication and payment.
• Partner with the future state designer, internal SMEs, technology teams, and consultants to define future state workflows, business requirements, operating model changes, and design decisions required to implement QNXT claims capabilities.
• Own governance for the claims implementation workstream, including status reporting, risk and issue management, decision tracking, escalation management, and communication to leadership and program stakeholders.
• Ensure all claims-related deliverables are completed with quality and traceability, including requirements, process designs, configuration inputs, conversion needs, test scenarios, defect resolution plans, readiness criteria, and go-live support materials.
• Coach and coordinate the broader cross-functional team, including program managers and SMEs, by establishing clear ownership, promoting disciplined execution, resolving barriers, and driving accountability for commitments and outcomes.
• Manage day-to-day collaboration with implementation consultants and vendors to ensure scope, deliverables, timelines, and design decisions align with business objectives, operational needs, and enterprise governance standards.
• Lead claims implementation readiness for testing, mock conversions, cutover, and go-live by confirming operational preparedness, validating defect remediation and contingency plans, and supporting a stable transition from legacy to future state operations.
• Drive continuous improvement across the implementation by identifying execution risks, workflow gaps, and dependency failures early, and implementing corrective actions that protect timeline, quality, claims accuracy, and stakeholder confidence.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Benefits

• Base Wage Range: $51.06 - $73.90 hourly
• Medical Benefits
• Paid Sick Time
• Excellent 401(k) Retirement Saving Plan
• Robust employee recognition program
• An opportunity to become part of a team that makes a difference to our members and our community every day!
• A competitive compensation and benefits program
• An annual employee bonus program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year
• Excellent Retirement Savings program
• A work-life balance

What This Job Offers

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