Healthcare Transformation Lead

Claddagh Resources; Minneapolis (MN); On-site; USD 180,000 - 240,000; Full time

Job summary

Claddagh Resources is seeking a senior transformation leader to shape and drive AI-led reinvention for major US healthcare payer organizations. The role sits at the intersection of payer domain strategy, AI innovation, and large-scale program execution, with responsibility for defining transformation roadmaps and value cases at the highest client levels.

You will lead efforts across claims modernization, prior authorization, provider and member engagement, and data, acting as a trusted advisor

Qualifications

• Deep domain expertise in US healthcare payer and leadership on end-to-end transformation programs.
• Strong CXO-level advisory experience with payers.
• Experience with AI/GenAI in large-scale payer programs.

Responsibilities

• Define and lead AI-led payer transformation visions across core processes.
• Identify high-impact AI use cases and drive incubation and scaling.
• Partner with delivery teams on platform modernization and enterprise architecture.
• Lead large deal pursuits with industry-focused proposals and workshops.

Skills

Payer transformation leadership

AI strategy

CXO stakeholder management

US healthcare payer domain

Program leadership

Job description

US Healthcare Payer Transformation Lead, Life Sciences and Healthcare Consulting

Locations: Chicago, IL | New Jersey | Minneapolis, MN | Connecticut

A global tier-1 IT services and consulting firm is seeking a senior transformation leader to shape and drive AI-led reinvention for major US healthcare payer organizations. This is a high-visibility consulting leadership role sitting at the intersection of payer domain strategy, AI and GenAI innovation, and large-scale program execution.

You will define forward-looking transformation strategies for payer clients, reimagining core business processes across claims, prior authorization, provider and member engagement, and data. Operating as a CXO-level advisor to COOs, CIOs, and CDOs, you will shape transformation roadmaps, build value cases, and influence business and technology decisions at the highest levels of client organizations.

What you will do:

• Define and lead AI-led payer transformation visions spanning claims modernization, prior authorization, payment integrity, contact center, clinical transformation, and value-based care
• Identify high-impact AI and GenAI use cases such as autonomous claims adjudication and conversational AI for member and provider interactions, and drive their incubation and scaling
• Partner with delivery and engineering teams on payer platform modernization strategies, including core admin systems and digital front door
• Lead large deal pursuits with domain-led solutioning and proposal input, and run AI transformation workshops as an industry authority
• Build reusable payer frameworks, solution accelerators, and reference architectures, and publish whitepapers and points of view

What you bring:

• Deep domain expertise and leadership in US healthcare payer, with techno-functional command of Medicare, Medicaid, and Commercial lines of business
• A proven track record leading end-to-end payer transformation programs
• Strong CXO-level stakeholder management and advisory experience with US payer clients
• Deep understanding of payer operating models and data flows across claims, provider, membership, and care management
• Knowledge of regulatory mandates and interoperability requirements

Candidates must be authorized to work in the United States without sponsorship.