Client Solution Executive

ClaimsCore EPMO Program | Healthcare Transformation

Position Summary

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.

Key Responsibilities

Executive Leadership & Strategic Advisory

• 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.

Enterprise Program Management Office (EPMO)

• 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. 

Technical Operations & Solution Engineering

• 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. 

Claims Accuracy & Operational Excellence

• 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. 

Platform Integration & Business Transformation

• 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.

Organizational Change Management

• 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.

Advisory Services & Innovation

• 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. 

Required Qualifications

• 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.

Preferred Qualifications

• 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.

Key Competencies

• Executive Presence
• Strategic Thinking
• Healthcare Transformation Leadership
• Enterprise Program Governance
• Solution Strategy Development
• Executive Communication
• Risk & Compliance Management
• Change Leadership
• Vendor & Partner Management
• Stakeholder Engagement
• Data-Driven Decision Making
• Claims Transformation Expertise

Success Measures

The Executive Solution Executive will be measured on:

• Achievement of Client program objectives and business outcomes.
• Executive stakeholder satisfaction and engagement.
• Program governance effectiveness and risk mitigation.
• Claims accuracy and operational performance improvements.
• Successful delivery of modernization and transformation initiatives.
• Organizational adoption and change readiness.
• Quality and timeliness of executive reporting and decision support. 

Ideal Candidate Profile

A seasoned healthcare transformation executive who combines deep payer operations expertise, enterprise program leadership, solution strategy, and executive consulting capabilities to guide complex client modernization initiatives from vision through execution. This leader is equally comfortable engaging C-suite stakeholders, leading transformation programs, advising on platform strategy, and ensuring measurable business value through operational excellence, governance, and innovation.

Salary Range

Now, a little about us …

At Tegria, we bring bold ideas and breakthroughs to improve care, technology, revenue, and operations in ways that move healthcare organizations from patient-centered to human-centered. We are helping healthcare put people first—both patients and those who dedicate their lives to delivering care.

And at the very core of this vital work is our incredibly talented people.

People with different backgrounds who welcome challenge and change. People who listen first, ask hard questions, and make decisions to cultivate a culture of equity and inclusion. People who chase after goals, growth, and generosity. We’re real. We’re nimble, and we believe in our mission to humanize healthcare.

Perks and benefits

Top talent deserves top rewards. We’ve carefully curated a best-in-class benefits package, meant to meet you wherever you are in your life and career.

• Your health, holistically. We offer a choice of multiple health and dental plans with nationally recognized networks, as well as vision benefits, a total wellness program, and an employee assistance program for you and your family.
   

• Your financial well-being. We offer competitive wages, retirement savings plans, company-paid disability and life insurance, pre-tax savings opportunities (HSA and/or FSA), and more.
   

• And everything in between. Our lifestyle benefits are unrivaled, including professional development offerings, opportunities for remote work, and our favorite: a generous paid-time-off program, giving you the flexibility to plan a vacation, take time away for illness (or life’s important events), and shift your schedule to accommodate those unexpected curve balls thrown your way.
   

Tegria is an equal employment opportunity employer and provides equal employment opportunities (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. All qualified candidates are encouraged to apply.