Director, Configuration (EDI & Inbound Claims)

Molina Talent Acquisition; United States; Remote; USD 120,000 - 170,000; Full time

Job summary

Molina Healthcare seeks a seasoned product leader to drive delivery and maintenance of enterprise products, aligning with regulatory requirements and enterprise strategy. You will bridge business goals with technical delivery, guiding architecture, data, QA, and operations teams to deliver measurable outcomes.

You will oversee configuration, benefit systems, and contract work streams while developing a clear product vision and backlog items in collaboration with stakeholders.

Qualifications

• At least 8 years of experience in product ownership, product management, business analysis or technical solution delivery.
• At least 3 years of management/leadership experience.
• Demonstrated experience working within Agile/Scrum delivery models.
• Experience supporting technical products such as enterprise platforms, configuration tools, data solutions, integrations or operational systems.
• Strong understanding of software development lifecycles and Agile principles.
• Proven ability to write clear, testable user stories and acceptance criteria.
• Experience prioritizing work in complex, highly regulated environments.
• Strong analytical and problem‑solving skills.
• Excellent communication skills with the ability to influence across technical and non‑technical audiences.
• Ability to operate effectively in ambiguity and make decisions with incomplete information.

Responsibilities

• Directs configuration team and demonstrates accountability for team performance.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department‑specific goals.
• Coordinates activities of assigned work function and/or department related activities ensuring efficiency and prioritization.
• Strategically plans, leads, and manages configuration workflow processes.
• Continuously identifies and executes opportunities for operational efficiencies and develops best practice approaches for assigned operational areas.
• Identifies appropriate resources are available to achieve department goals – escalates resource needs, rationale, and deficiencies to leadership.
• Ensures appropriate follow‑up and communication occurs on direct assignments, and activities and tasks that fall within the scope of configuration.
• Ensures team compliance with applicable federal/state regulations and internal policies/procedures.
• Owns and communicates a clear product vision aligned to enterprise strategy and operational outcomes.
• Partners with business stakeholders to understand problems, desired outcomes, constraints and regulatory obligations.
• Directs the development and implementation of contract, benefit configuration and fee schedules.
• Directs the implementation and maintenance of member benefits in the claims payment system and other applicable systems.
• Supports critical business strategies by providing systematic solutions and/or recommendations on business processes.
• Plans for long‑term success of the department and individual health plans – focusing on goals and improvements to daily operations.
• Builds and maintains strong trusted relationships with key stakeholders including health plan leadership and other cross‑functional departments; presents data and opportunities to stakeholders and collaborates on performance improvement initiatives.
• Collaborates closely with engineering, architecture, data, QA, operations teams, and Health Plans to ensure solutions are feasible, scalable and supportable.
• Partners with health plan, compliance, legal and audit teams as needed to support reviews and implementations.
• Supports enterprise goals related to standardization and reduction of unmanaged complexity.
• Partners closely with stakeholders to clarify requirements and translate needs into backlog items.

Skills

Product ownership

Leadership

Agile/Scrum

Stakeholder management

User stories

Analytical skills

Communication

Decision making

Ambiguity handling

Tools

Jira

Azure DevOps

Rally

SQL

Job description

JOB DESCRIPTION

***Remote and must live in the United States***

Job Summary

Leads and directs team responsible for the delivery, execution and maintenance of products. Accountable for maximizing the value of assigned technical products that support enterprise operations. Leads the product vision, backlog, and delivery outcomes and serves as the primary bridge between business stakeholders and technical delivery teams. Ensures solutions align to business outcomes, regulatory requirements, and enterprise strategy, while partnering closely with engineering, architecture, data, QA and operations teams on how solutions are delivered.

Job Duties

• Directs configuration team and demonstrates accountability for team performance - including meeting or exceeding established performance targets; targets may be based upon specific health plan requirements, and/or federal/state requirements.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department‑specific goals
• Coordinates activities of assigned work function and/or department related activities ensuring efficiency and prioritization.
• Strategically plans, leads, and manages configuration workflow processes.
• Continuously identifies and executes opportunities for operational efficiencies and develops best practice approaches for assigned operational areas, ensuring achievement of organizational/department goals.
• Identifies appropriate resources are available to achieve department goals – escalates resource needs, rationale, and deficiencies to leadership.
• Ensures appropriate follow‑up and communication occurs on direct assignments, and activities and tasks that fall within the scope of configuration.
• Ensures team compliance with applicable federal/state regulations and internal policies/procedures.
• Owns and communicates a clear product vision aligned to enterprise strategy and operational outcomes.
• Partners with business stakeholders to understand problems, desired outcomes, constraints and regulatory obligations.
• Directs the development and implementation of contract, benefit configuration and fee schedules.
• Directs the implementation and maintenance of member benefits in the claims payment system and other applicable systems.
• Supports critical business strategies by providing systematic solutions and/or recommendations on business processes.
• Plans for long‑term success of the department and individual health plans – focusing on goals and improvements to daily operations.
• Builds and maintains strong trusted relationships with key stakeholders including health plan leadership and other cross‑functional departments; presents data and opportunities to stakeholders and collaborates on performance improvement initiatives.
• Collaborates closely with engineering, architecture, data, QA, operations teams, and Health Plans to ensure solutions are feasible, scalable and supportable.
• Partners with health plan, compliance, legal and audit teams as needed to support reviews and implementations.
• Supports enterprise goals related to standardization and reduction of unmanaged complexity.
• Partners closely with stakeholders to clarify requirements and translate needs into backlog items.

Job Qualifications

REQUIRED QUALIFICATIONS:

• At least 8 years of experience in product ownership, product management, business analysis or technical solution delivery.
• At least 3 years of management/leadership experience.
• Demonstrated experience working within Agile/Scrum delivery models.
• Experience supporting technical products such as enterprise platforms, configuration tools, data solutions, integrations or operational systems.
• Strong understanding of software development lifecycles and Agile principles.
• Proven ability to write clear, testable user stories and acceptance criteria.
• Experience prioritizing work in complex, highly regulated environments.
• Strong analytical and problem‑solving skills.
• Excellent communication skills with the ability to influence across technical and non‑technical audiences.
• Ability to operate effectively in ambiguity and make decisions with incomplete information.

PREFERRED QUALIFICATIONS:

• Prior Product Owner or Product Manager certification strongly preferred at time of hire.
• Experience with enterprise platforms, APIs, integrations or configuration‑heavy systems.
• Experience in healthcare, financial services or other regulated industries.
• Familiarity with Agile tooling (e.g., Jira, Azure DevOps, Rally).
• Developing and writing SQL queries
  

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