Director, Claims Systems and Electronic Data Interchange

Department: Information Systems
Reports To: VP IS Analytics and Development
Supervises: Managers and Supervisors
Location: Remote (Must be available to work Pacific Time Zone (PST) hours)

Description:
Impresiv Health is seeking an experienced Director, Claims Systems and Electronic Data Interchange (EDI) to lead the development, execution, operational performance, and ongoing maintenance of mission-critical healthcare claims processing and EDI systems.

This leadership role is responsible for ensuring the stability, scalability, and reliability of claims processing environments across multiple lines of business. The Director will oversee Claims and EDI operations, drive system improvements, support modernization initiatives, and collaborate with cross-functional stakeholders to ensure technology solutions meet evolving business and operational needs.

The ideal candidate brings extensive experience in healthcare claims systems, particularly QNXT, along with strong technical leadership, systems implementation, and EDI expertise within a managed care environment.

What You Will Do:

• Lead the development, implementation, support, and ongoing maintenance of enterprise Claims and EDI systems across multiple lines of business.
• Oversee the operational performance, stability, scalability, and reliability of mission-critical claims processing environments.
• Direct the maintenance, upgrades, enhancements, expansions, architecture, and modernization of Claims and EDI platforms.
• Establish and lead a dedicated Claims System Implementation Team to support system initiatives and operational priorities.
• Execute strategic technology initiatives and implementation plans that align with organizational objectives.
• Develop and implement modernization strategies to reduce operational risk, improve system maintainability, and enhance overall performance.
• Oversee internally developed and third-party applications essential to claims processing and EDI operations.
• Partner with business and technology leaders to identify operational needs, address system challenges, and deliver effective solutions.
• Lead managers, supervisors, and technical teams responsible for claims systems development, support, and operational execution.
• Evaluate existing systems and processes to identify opportunities to improve efficiency, agility, and long-term sustainability.

You Will Be Successful If:

• You have a strong understanding of healthcare claims processing systems, QNXT, and Electronic Data Interchange (EDI) operations.
• You can effectively lead technical teams responsible for complex, business-critical healthcare applications.
• You have demonstrated success maintaining and improving enterprise claims processing environments.
• You can translate complex technical challenges into practical solutions that support business operations.
• You are experienced in leading system implementations, upgrades, and modernization efforts while minimizing operational disruption.
• You thrive in collaborative environments and can build productive relationships with technical teams, business stakeholders, and executive leadership.
• You can manage competing priorities while maintaining high standards for system performance, reliability, and service delivery.
• You possess excellent communication and leadership skills, with the ability to present complex technical information to staff, senior leadership, and executive stakeholders.

What You Will Bring:

• Bachelor's degree in Information Systems, Business, Healthcare, or a related field.
• Minimum of 10 years of relevant professional experience in information systems, healthcare technology, claims processing, or related functions.
• Minimum of 5 years of experience managing information services teams, including managers, supervisors, or technical professionals.
• Strong knowledge of QNXT claims processing systems and EDI platforms, including their integration with healthcare business operations.
• Demonstrated experience leading Claims and EDI teams or organizations.
• Experience managing application development, technical support, and vendor management teams.
• Proven experience supporting the re-architecture or significant transformation of business-critical systems.
• Experience leading enterprise-level change initiatives and complex technology implementations.
• Experience managing service-oriented organizations with diverse stakeholders and evolving business priorities.
• Strong technical problem-solving, organizational leadership, and stakeholder communication skills.

Preferred Qualifications:

• Hands-on leadership experience with QNXT system implementations, upgrades, or enhancements.
• Experience with Microsoft Azure and Azure Logic Apps, particularly in support of EDI integration and modernization.
• Familiarity with IT Service Management (ITSM) and IT Infrastructure Library (ITIL) frameworks.
• Experience working with Electronic Health Record (EHR) systems.
• Healthcare payer or managed care industry experience.
• Knowledge of Medicaid, Medicare, and managed care operations.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That’s Impresiv!