Senior Manager Service Delivery

Summary

We are seeking a Senior Manager to lead service delivery and operational execution for healthcare claims configuration and processing teams. This role will drive delivery excellence, quality, and continuous improvement across configuration, adjudication, and support functions to improve accuracy, efficiency, and client outcomes.

Your role in our mission

• Manages multiple clients and domain leads responsible for claims configuration, provider setup, and adjudication logic to ensure accurate and efficient delivery of business solutions. Drives standardization and implementation of process improvements across configuration lifecycle (design, build, test, deploy).
• Develops and manages demand forecasts with account and product teams, aligning configuration and delivery capacity with client priorities. Identify risks in workload, capacity, and delivery timelines and recommend mitigation strategies.
• Works with functional and technical teams to interpret regulatory, benefit, and pricing requirements into configuration solutions. Provides guidance on solution design, impacts to claims adjudication, and downstream processing.
• Prepares, recommends, and oversees operating and personnel budgets for assigned teams. Monitors spend against plan, identifies variances, and drives cost optimization while maintaining delivery quality and SLA commitments.
• Leads complex relationships between delivery teams, product engineering, and client stakeholders to ensure alignment on configuration changes, defect resolution, and release readiness. Resolves escalations and ensures timely issue resolution.
• Drives continuous service improvements focused on accuracy of configuration, reduction of defects, and improved turnaround times. Ensure delivery outcomes meet client expectations for quality, compliance, and timeliness.
• Partners with product engineering, QA, and operations teams to integrate new and enhanced capabilities into configuration frameworks and claims processing workflows.
• Supports new business initiatives by contributing to solution design, estimation, and proposal development, particularly in areas involving claims configuration, pricing, and benefit setup.
• Selects and hires employees with strong domain expertise in healthcare claims and configuration. Coaches and develop team members to enhance technical capability, domain knowledge, and leadership skills. Addresses performance issues and drives accountability for results.

What we're looking for

• Bachelor's degree or higher in business administration, healthcare, information systems, or related field
• Twelve (12) or more years of experience in healthcare technology, claims processing, configuration, or related delivery roles
  Eight (8) or more years of leadership or supervisory experience
• Experience working in healthcare payer systems, including Medicaid or Medicare environments
• Experience working with core administration platforms such as QNXT, Facets, or equivalent healthcare claims systems
• Demonstrates strong expertise in healthcare claims processing, including edit configuration and pricing methodologies, with advanced analytical and problem-solving capabilities (root cause analysis, defect reduction), and excellent communication and relationship-building skills to effectively collaborate with clients, stakeholders, and cross-functional teams while translating complex concepts into business terms.

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
• Monday through Friday work schedule (40 hours per week).
• Travel may be required on occasion.
• Health (medical, dental, vision) benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. Any exception requires manager approval prior to employee's Gainwell start date.
• Company provided computer for work use.
• For all hybrid and remote positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload.  Greater speeds will of course provide better performance.
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
• The use of AI during interviews is prohibited.
• This position will accept applications until June 30, 2026.

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