Director, Applications - Claims Processing - Remote

Molina Healthcare; United States; Remote; USD 130,000 - 180,000; Full time

Job summary

Molina Healthcare is seeking an accomplished senior leader to direct teams delivering Azure-based applications for Medicare/Medicaid processes. You will drive AI-first development, leverage Azure services, and promote cloud-native architectures with strong governance and security.

The role emphasizes end-to-end ownership, collaboration with business stakeholders, and advancing enterprise automation and QA. Remote-friendly hybrid arrangements and a focus on payor operations are possible depending

Qualifications

• Minimum 8 years IT applications/coding development in large organizations; healthcare/payor experience preferred.
• At least 3 years of management/leadership experience.
• Advanced experience with Microsoft Azure cloud services (App Services, Functions, AKS, Azure SQL, Data Factory, Synapse, DevOps).
• Expert proficiency with Visual Studio and AI-assisted development using GitHub Copilot and Azure AI services.
• Experience leading enterprise QA automation strategy and implementing testing frameworks at organizational scale.
• Advanced experience with low-code platforms (Pega, Salesforce, Sitecore) and enterprise architecture patterns.
• Hands-on with .NET framework and Azure serverless technologies.
• Fluent in modern DevOps frameworks based on Azure DevOps or Atlassian framework.
• Ability to build strategic relationships across executive leadership and influence organizational outcomes.

Responsibilities

• Own Claims Custom Solutions portfolio supporting adjudication, payment integrity, provider reimbursement, accumulators, authorization integration, workflow, and regulatory programs.
• Govern solution intake, prioritization, funding, and lifecycle management across all claims-related custom solutions.
• Partner with Claims Operations, Product, Payment Integrity, Provider Services, and Health Plans to identify business problems and deliver scalable solutions.
• Drive AI-enabled claims automation, decision support, anomaly detection, and operational intelligence initiatives.
• Establish KPIs for claims inventory reduction, auto-adjudication improvement, processing efficiency, and operational cost reduction.
• Oversees team of Forward Deployed Engineers responsible for developing software applications on Microsoft Azure to meet key business objectives; establishes performance metrics aligned with health care payor outcomes.
• Drives team culture of end-to-end ownership, ensuring engineers take ownership of business problems rather than functioning as point solution experts.
• Project manages applications implementation, integration, and enhancements using Azure DevOps and Agile methodologies at scale.
• Leads enterprise quality assurance automation strategy and ensures team adoption of automated testing practices.

Skills

Azure cloud

Visual Studio

GitHub Copilot

Azure DevOps

AI/ML development

Leadership

CI/CD

DevOps

Low-code platforms

Healthcare domain

Tools

Pega

Salesforce

Sitecore

Azure Monitor

Application Insights

Trizetto QNXT

Job description

JOB DESCRIPTION Job Summary

Leads and directs team responsible for applications activities on Microsoft Azure cloud infrastructure. Responsible for designing, developing, and communicating technology models and foundations used to run applications, data, and infrastructure in support of health care payor business processes serving Medicare/Medicaid members. Applies and promotes key principles (stability, scalability, performance, security, compatibility, re-use) leveraging Azure services, AI-first development practices using Visual Studio with GitHub Copilot, and integrations with low-code platforms (Pega, Salesforce, Sitecore) to ensure a balance between tactical and strategic technology solutions. Drives a team culture of end-to-end ownership, cross-functional collaboration, and business partnership. Ensures team effectively partners with business stakeholders across clinical, financial, and operational functions to deliver measurable outcomes that improve member health and organizational efficiency. Champions adoption of Azure cloud-native architecture patterns, AI/ML capabilities, and quality assurance automation excellence. Promotes use of industry and enterprise technology standards, evaluates emerging technologies for application, and ensures adherence to design and application development standards, methodologies and frameworks within architectural compliance and governance.

Essential Job Duties

• Own Claims Custom Solutions portfolio supporting adjudication, payment integrity, provider reimbursement, accumulators, authorization integration, workflow, and regulatory programs.
• Govern solution intake, prioritization, funding, and lifecycle management across all claims-related custom solutions.
• Partner with Claims Operations, Product, Payment Integrity, Provider Services, and Health Plans to identify business problems and deliver scalable solutions.
• Drive AI-enabled claims automation, decision support, anomaly detection, and operational intelligence initiatives.
• Establish KPIs for claims inventory reduction, auto-adjudication improvement, processing efficiency, and operational cost reduction.
• Oversees team of Forward Deployed Engineers responsible for developing software applications on Microsoft Azure to meet key business objectives; establishes performance metrics aligned with health care payor outcomes.
• Drives team culture of end-to-end ownership, ensuring engineers take ownership of business problems rather than functioning as point solution experts.
• Champions AI-first development practices, ensuring team leverages Visual Studio with GitHub Copilot, Azure AI services, and machine learning capabilities.
• Project manages applications implementation, integration, and enhancements using Azure DevOps and Agile methodologies at scale.
• Leads enterprise quality assurance automation strategy and ensures team adoption of automated testing practices.
• Drives strategic integration with low-code platforms (Pega, Salesforce, Sitecore) to maximize enterprise technology investments.
• Manages key vendor relationships and strategic Azure cloud service partnerships.
• Manages support activities (break fix, operations, large requests) to meet established service levels on Azure infrastructure.
• Takes a key leadership role in evolving Molina application development and design practices toward cloud-native, AI-enabled solutions.
• Leads design and architecture reviews ensuring compliance with Azure Well-Architected Framework and security standards.
• Collaborates with enterprise project management office and business analysts to deliver strategic Medicare/Medicaid initiatives.
• Develops software (hands-on code development) on Azure to meet key business objectives as needed.
• Designs enterprise cloud-native software applications solving complex health care payor business problems.
• Gathers business requirements and develops conceptual and technical designs for multiple large-scale projects concurrently.
• Conducts reviews of developers (internal and contract staff) ensuring standards, quality, and enterprise architecture alignment.
• Leads build versus buy evaluation with strategic consideration of Azure marketplace and platform capabilities.
• Leads architecture and design discussions ensuring adherence to Azure cloud patterns and enterprise standards.
• Provides design and architectural expertise to technical teams, business partners, and leadership.
• Supports application system/service owner for system performance, budgeting and planning on Azure infrastructure.
• Monitors application stability and scalability leveraging Azure Monitor, Application Insights, and proactive alerting.
• Ensures alignment with project methodologies, change management, and enterprise governance processes.
• Organizes, manages and leads cross-team project tasks and deliverables across technical and business functions.
• Drives cross-functional collaboration ensuring technical teams partner effectively with business stakeholders.
• Ensures HIPAA compliance and health care data governance standards are maintained across all solutions.
• Hires, trains, mentors, and develops a high-performing team with Forward Deployed Engineer mindset; demonstrates accountability for team performance and department goals.

Required Qualifications

• At least 8 years of information technology (IT) applications/coding development experience in large organizations in the managed care industry, or equivalent combination of relevant education and experience.
• At least 3 years of management/leadership experience.
• Advanced experience with Microsoft Azure cloud services (App Services, Functions, AKS, Azure SQL, Data Factory, Synapse, Azure DevOps).
• Expert proficiency with Visual Studio and AI-assisted development using GitHub Copilot and Azure AI services.
• Experience leading enterprise quality assurance automation strategy and implementing testing frameworks at organizational scale.
• Advanced experience with low-code platforms (Pega, Salesforce, Sitecore) and enterprise architecture patterns.
• Advanced technical experience with IT enterprise infrastructure and Azure cloud architecture.
• Health care payor industry experience, including Medicare/Medicaid operations and compliance knowledge.
• Specific domain expertise with government programs (Medicaid, Medicare, Marketplace).
• Microsoft technologies, Mobility and Information Technology Infrastructure Library (ITIL) experience.
• Experience working with Trizetto QNXT application and enterprise health care systems.
• Advanced understanding of IT concepts including test automation, software development lifecycle (SDLC), and IT general controls.
• Hands-on experience with .NET framework and Azure serverless technologies.
• Experience with global delivery models and working with third-party consultancies.
• Fluent in modern DevOps frameworks based on Azure DevOps or Atlassian framework.
• Forward Deployed Engineer leadership philosophy - proven track record building teams focused on end-to-end business ownership.
• Demonstrated ability to build strategic relationships across executive leadership and influence organizational outcomes.
• Strong critical-thinking and problem-solving skills with focus on business transformation.
• Advanced knowledge/experience with agile principles, CI/CD practices, DevOps culture, and Infrastructure as Code.
• Strong time-management and organizational skills with ability to lead strategic, multi-team initiatives.
• Ability to collaborate cross-functionally in a highly matrixed organization and influence at executive levels.
• Excellent verbal and written communication skills, and ability to present to executive audiences.
• Experience with Microsoft Project/Jira, Microsoft O365 Cloud, Power BI, Azure DevOps, and applicable software programs proficiency.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V