Program Lead, QNXT Implementation - SCAN Temp

Scan-Health-Plan; Lakewood (CA); Hybrid; USD 70,340 - 101,804; Full time

Benefits offered by this job

Medical Benefits

Paid Sick Time

401(k) Retirement Plan

Employee recognition program

Job summary

SCAN Temp seeks an experienced Program Lead to head the QNXT implementation for the Claims workstream, guiding end-to-end planning, execution, and go-live readiness. You will coordinate with Claims, Provider Data, and Configuration teams, ensure quality deliverables, and manage risks across a complex program.

You will collaborate with SME teams and external consultants to define future-state workflows, operating model changes, and design decisions required to implement QNXT claims capabilities.

Qualifications

• Bachelor’s degree or equivalent combination of education and experience in Business, Health Administration, Information Systems, or related fields.
• Master’s degree preferred (MBA, MPH, MS in Health Admin, IS, or related).
• Minimum 6 years of related experience in health plan, healthcare, or related industry.
• Strong knowledge of healthcare payer claims operations, end-to-end claims lifecycle, and business processes for accurate adjudication and payment.
• Experience leading large cross-functional system implementations or business transformations involving claims, data, testing, and operational readiness.
• Knowledge of QNXT or comparable core administrative platforms and related upstream/downstream functions.

Responsibilities

• You Will lead the Claims implementation of QNXT with end-to-end responsibility for planning, execution, issue resolution, and delivery of migration from IKA.
• Coordinate and drive alignment across Claims, Provider Data, and Configuration workstreams for contracts, benefits, UM/business rules, and capitation.
• Own governance for the claims implementation workstream including status reporting, risk/issue management, and leadership communication.
• Coach and coordinate cross-functional teams to ensure disciplined execution and accountability.
• Manage day-to-day collaboration with implementation consultants and vendors to align scope, timelines, and design decisions.
• Lead readiness activities for testing, mock conversions, cutover, and go-live; ensure operational preparedness and contingency plans.
• Drive continuous improvement by identifying risks, workflow gaps, and dependency failures and implementing corrective actions.
• Support testing, defect triage, operational readiness, cutover planning, and go-live stabilization for major platform transitions.

Skills

Cross-functional leadership

Executive communication

Stakeholder management

Facilitation

Problem solving

Risk management

Coaching

Change leadership

Team leadership

Education

Bachelor’s degree or equivalent

Master’s degree preferred

Tools

SQL

Visio

Microsoft Office

Job description

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do.Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.The JobThe Program Lead, QNXT Implementation - SCAN Temp is the accountable leader for successful implementation of the Claims workstream within the QNXT core platform transformation, including migration from the current IKA platform. This role directs end-to-end planning, execution, governance, and delivery across claims-related workstreams and coordinates closely with supporting product managers for Claims, Provider Data, and Configuration (including provider contracts, benefits, UM/business rules, and capitation), future state design, internal subject matter experts, and external consultants.The role is responsible for ensuring all deliverables are completed with quality and on schedule, risks and dependencies are actively managed, teams are coached and aligned, and the organization is operationally ready for testing, cutover, and go-live.You WillServe as the accountable program lead for the Claims implementation of QNXT, with end-to-end responsibility for planning, execution, issue resolution, and successful delivery of the claims migration from IKA.Lead the integrated claims implementation plan across business, operational, configuration, data, testing, training, readiness, and cutover activities; ensure milestones, deliverables, and dependencies are clearly defined, monitored, and achieved.Coordinate and drive alignment across supporting workstreams, including Claims, Provider Data, and Configuration for provider contracts, benefits, UM/business rules, and capitation, to ensure an end-to-end solution that supports accurate claim adjudication and payment.Partner with the future state designer, internal SMEs, technology teams, and consultants to define future state workflows, business requirements, operating model changes, and design decisions required to implement QNXT claims capabilities.Own governance for the claims implementation workstream, including status reporting, risk and issue management, decision tracking, escalation management, and communication to leadership and program stakeholders.Ensure all claims-related deliverables are completed with quality and traceability, including requirements, process designs, configuration inputs, conversion needs, test scenarios, defect resolution plans, readiness criteria, and go-live support materials.Coach and coordinate the broader cross-functional team, including program managers and SMEs, by establishing clear ownership, promoting disciplined execution, resolving barriers, and driving accountability for commitments and outcomes.Manage day-to-day collaboration with implementation consultants and vendors to ensure scope, deliverables, timelines, and design decisions align with business objectives, operational needs, and enterprise governance standards.Lead claims implementation readiness for testing, mock conversions, cutover, and go-live by confirming operational preparedness, validating defect remediation and contingency plans, and supporting a stable transition from legacy to future state operations.Drive continuous improvement across the implementation by identifying execution risks, workflow gaps, and dependency failures early, and implementing corrective actions that protect timeline, quality, claims accuracy, and stakeholder confidence.We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.Actively support the achievement of SCAN’s Vision and Goals.Other duties as assigned.Your QualificationsBachelor’s degree or equivalent combination of education and experience - Business, Health Administration, Information Systems, or related fields.Master’s degree (preferred) - MBA, MPH, MS in Health Administration, Information Systems, or related field.Minimum 6 years related experience with in the health plan, healthcare, or related industry.Strong knowledge of healthcare payer claims operations, end-to-end claims lifecycle, and business processes required to support accurate adjudication, pricing, payment, and issue resolution. Experience leading large, cross-functional system implementations or businesstransformations involving claims, operations, configuration, data, testing, and operational readiness.Working knowledge of QNXT or comparable core administrative platforms, including the relationship between claims processing and upstream/downstream functions such as provider data, benefits, contracts, UM/business rules, and capitation.Ability to build and manage integrated workplans, deliverables, RAID logs, decision logs, and governance routines in a complex program environment.Ability to translate strategy and future state design into clear business requirements, implementation priorities, accountable owners, and executable plans.Strong facilitation, communication, and influencing skills, with the ability to align senior leaders, SMEs, operational teams, and consultants around decisions, priorities, and timelines.Demonstrated ability to coach teams, drive accountability, and elevate performance in fast-paced, ambiguous, and high-stakes transformation environments.Strong analytical and problem-solving skills, including the ability to assess risks, surface tradeoffs, resolve blockers, and make sound decisions with incomplete information.Experience supporting implementation testing, defect triage, operational readiness, cutover planning, and go-live stabilization for major platform transitions.Ability to balance strategic transformation goals with day-to-day operational realities to deliver a stable, controlled, and business-ready migration from IKA to QNXT.Program leadership and accountability.Strategic planning and execution discipline.Cross-functional collaboration and influence.Executive communication and stakeholder management.Coaching, team leadership, and talent development.Risk management and decision making.Change leadership and organizational readiness.Consultant and vendor management.Operational excellence and results orientation.Advanced Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, Access), Visio, and SQL required.SCAN TempWhat's in it for you?This is a temporary opportunity for a limited period of timeBase Wage Range: $51.06 - $73.90 hourlyWork Mode: Partially RemoteMedical BenefitsPaid Sick TimeExcellent 401(k) Retirement Saving PlanRobust employee recognition programAn opportunity to become part of a team that makes a difference to our members and our community every day!We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.#LI-MS1#LI-HybridEqual Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)