Director, Applications - Claims Processing

Accountabilities: Lead the claims custom-solutions portfolio covering adjudication, payment integrity, provider reimbursement, accumulators, authorization integration, workflow, and regulatory initiatives. Govern solution intake, prioritization, funding, delivery, lifecycle management, and operational support across claims-related applications. Partner with Claims Operations, Product, Payment Integrity, Provider Services, Health Plans, and other business stakeholders to translate complex business needs into scalable technology solutions. Lead and develop a team of Forward Deployed Engineers, establishing performance expectations centered on end-to-end ownership and measurable healthcare business outcomes. Champion AI-first development practices using Visual Studio, GitHub Copilot, Azure AI services, and machine-learning capabilities. Drive cloud-native application architecture and development across Azure services, including App Services, Functions, AKS, Azure SQL, Data Factory, Synapse, and Azure DevOps. Lead enterprise quality-assurance automation strategies and promote automated testing, CI/CD, Agile delivery, and DevOps practices. Oversee application implementations, integrations, enhancements, support activities, break-fix work, and large requests while maintaining established service levels. Drive strategic integrations with low-code platforms such as Pega, Salesforce, and Sitecore. Lead architecture and design reviews, ensuring alignment with Azure cloud patterns, the Azure Well-Architected Framework, security standards, enterprise architecture, HIPAA, and healthcare data-governance requirements. Monitor application stability, performance, and scalability using tools such as Azure Monitor and Application Insights, while implementing proactive alerting and operational improvements. Manage strategic vendor relationships, Azure cloud partnerships, third-party consultancies, and build-versus-buy evaluations. Establish KPIs covering claims inventory reduction, auto-adjudication, processing efficiency, automation, quality, and operational cost reduction. Gather requirements and develop conceptual and technical designs for multiple large-scale initiatives while providing architectural guidance to technical teams and business leadership. Participate in hands-on software development on Azure when required and provide technical expertise across complex .NET and serverless solutions. Coordinate cross-functional projects, deliverables, governance, change management, budgeting, planning, and enterprise standards. Hire, mentor, train, and develop a high-performing engineering organization focused on business ownership, collaboration, accountability, and continuous improvement. Requirements At least 8 years of IT applications or software development experience within large organizations, preferably in the managed care or healthcare industry, or an equivalent combination of education and relevant experience. At least 3 years of management or technology leadership experience, including experience building and developing high-performing engineering teams. Advanced Microsoft Azure expertise, including App Services, Functions, AKS, Azure SQL, Data Factory, Synapse, Azure DevOps, and related cloud architecture capabilities. Strong proficiency with Visual Studio and AI-assisted development using GitHub Copilot and Azure AI services. Experience leading enterprise-scale quality assurance automation strategies and implementing testing frameworks. Advanced knowledge of low-code platforms such as Pega, Salesforce, and Sitecore and their integration within enterprise architectures. Healthcare payer experience, including knowledge of Medicare, Medicaid, Marketplace programs, healthcare operations, and regulatory requirements. Experience with Trizetto QNXT or comparable enterprise healthcare systems is required. Strong understanding of software development lifecycle, IT general controls, test automation, enterprise infrastructure, and cloud-native architecture. Hands-on experience with the .NET framework, Azure serverless technologies, Infrastructure as Code, CI/CD, Agile methodologies, and modern DevOps frameworks. Experience with Azure DevOps or Atlassian-based delivery environments, Microsoft Project or Jira, Microsoft 365, Power BI, and related enterprise technology tools. Experience working with global delivery models and third-party consulting organizations. Demonstrated ability to build strategic relationships, influence executive stakeholders, and lead transformation across a highly matrixed organization. Strong critical-thinking, problem-solving, organizational, and time-management skills, with the ability to manage multiple strategic initiatives simultaneously. Excellent written, verbal, presentation, and executive communication skills. Demonstrated ability to collaborate effectively across technical and business functions and translate complex technology concepts into business outcomes. Benefits Annual salary range of $105,958.12–$229,575.94 , with actual compensation varying based on factors such as geographic location, experience, education, and skill level. Competitive compensation and benefits package. Full-time, fully remote work arrangement within the United States. Opportunity to lead large-scale cloud, AI, and application modernization initiatives within the healthcare technology environment. Leadership responsibility spanning engineering, architecture, application delivery, automation, and business transformation. Opportunities to work with Microsoft Azure, AI-enabled development, DevOps, low-code platforms, and enterprise healthcare systems. Professional growth through strategic technology leadership and cross-functional collaboration.