Client Solution Executive

tegria; United States; On-site; USD 180,000 - 260,000; Full time

Job summary

tegria is seeking an Executive Solution Executive to lead the ClaimsCore EPMO and healthcare transformation initiatives. You will align executive stakeholders, oversee delivery, and shape strategy across dual-platform environments including ClaimsCore, PMO governance, and advisory services.

You will partner with client leadership, technology teams, operations, and vendors to drive program direction, risk mitigation, and measurable outcomes while ensuring compliance and transformational change

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.

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
• 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.

Skills

Executive leadership

Strategic advisory

Stakeholder management

Enterprise architecture understanding

PMO governance

Change management

Solution engineering

Education

Bachelor's degree in Healthcare Administration, Information Systems, Business Administration, Computer Science, or related field

Tools

Facets

HealthEdge

Job description

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 e