Jobs at HealthEdge

Designs, implements, operates, and optimizes enterprise network infrastructure across on-premises data centers, AWS, and other cloud environments. Responsibilities include routing, switching, firewalls, SD-WAN, VPNs, monitoring, network security, incident response, Tier 3 escalation, infrastructure as code, automation, documentation, disaster recovery support, and cross-functional collaboration. Participates in 24/7 on-call coverage and mentors junior engineers.

Owns customer outcomes, retention, referenceability, and expansion across enterprise healthcare accounts. The Senior Customer Success Executive develops success plans, manages account health and recovery programs, coordinates cross-functional delivery, identifies expansion opportunities, maintains accurate CRM and reporting data, and communicates with customer executives. The role requires deep health-plan operations knowledge, enterprise payer-platform experience, commercial fluency, and the ability to drive results through teams without direct authority.

Leads technical architecture and customer delivery integrations across claims, enrollment, provider, authorization, and payment systems. Governs solution architecture, collaborates with customers and partners, and drives automation, performance improvements, and emerging technology adoption. Requires extensive healthcare insurance integration experience, technical leadership, people management, AWS expertise, EDI transactions, and knowledge of enterprise integration technologies. The role is fully remote in the United States and may involve travel.

Own and prioritize the product backlog for a healthcare claims administration platform. Translate stakeholder needs into epics, user stories, acceptance criteria, workflows, and functional requirements. Coordinate with engineering, UX/UI, QA, Scrum teams, and other Product Owners throughout Agile delivery. Apply healthcare claims and reimbursement knowledge while supporting HIPAA and HITECH compliance. Use Jira and AI-enabled tools for backlog management and requirements development, communicate delivery updates, and resolve blockers.

Manages capacity planning, staffing allocation, utilization tracking, and forecasting for more than 1,200 global professional services resources. Analyzes project demand, workforce availability, billable utilization, and bench-time risks to guide staffing and hiring decisions. Maintains PSA scheduling and forecasting data, supports system migrations, and partners with GPS leadership, project managers, Finance, HR, sales, and international delivery teams.

Own the AI product strategy and roadmap for HealthEdge’s HealthRules Payer platform. Identify and prioritize AI use cases across claims, member management, enrollment, benefits, and contracts; translate strategy into product requirements; and align product, engineering, data science, UX, marketing, and sales teams. Lead AI governance, regulatory compliance, customer presentations, go-to-market messaging, pilots, and feature commercialization while ensuring responsible AI use in healthcare payer workflows.

Leads advisory engagements for health plans by assessing claims, enrollment, billing, and service operations; identifying cost, quality, and compliance gaps; developing future-state technology and operating-model roadmaps; and building ROI-based business cases for BPaaS transformation. Partners with sales, solution, and delivery teams while advising stakeholders from analysts through C-suite executives. Requires extensive health plan operations leadership, platform knowledge, financial modeling, transformation expertise, and team leadership.

Administer, configure, develop, and troubleshoot NetSuite and connected financial systems, including Zone Billing and SuiteProjects Pro. Support month-end close, reconciliations, data integrity, integrations, statutory reporting migration, user access controls, testing, and documentation. Partner with Accounting, FP&A, and IT teams on system enhancements and reporting needs while serving as backup to the Financial Systems Lead and developing toward systems architecture leadership.

Processes and adjudicates healthcare claims using client guidelines, policies, and procedures. Reviews claim data, coding, system edits, benefit coverage, and medical necessity to determine payment accuracy. Meets productivity and quality targets, communicates issues to management, mentors junior staff, and supports audits, documentation, training, provider data, authorization, enrollment, and other team projects.

Leads enterprise IAM strategy and operations across workforce, machine, cloud, and customer identities. Oversees identity providers, PAM, zero-trust architecture, SSO/MFA, RBAC, IaC, JIT access, automation, compliance, audits, and M&A integrations. Manages a globally distributed team of 5–7 direct reports, partners with technical and business stakeholders, and reports program health and risk to executives.

Leads and develops a team of Principal Consultants supporting complex GuidingCare healthcare payer implementations. Oversees delivery quality, capacity, assignments, client engagement, escalations, practice standards, hiring, and career development. Partners with delivery and project leadership on high-risk workstreams, pre-sales, scoping, requirements workshops, and continuous improvement. Requires extensive GuidingCare implementation expertise across care management, utilization management, appeals and grievances, and data integration.

Supports and manages onshore activities for a Salesforce-based healthcare product. Serves as the primary customer and stakeholder contact, learns product workflows, coordinates onshore and offshore teams, resolves and escalates issues, and ensures smooth operations. The role requires strong Salesforce consulting experience, customer communication, analytical problem-solving, independent prioritization, and collaboration across distributed teams.

Leads architecture, design, development, deployment, and production support for complex enterprise software and cloud-native solutions. Advises strategic customers, resolves critical technical issues across application and infrastructure layers, shapes product direction, and drives engineering excellence through modern development practices. Mentors engineers, guides architecture decisions, and collaborates with product, QA, DevOps, SRE, and infrastructure teams. The role primarily supports HealthEdge’s healthcare claims administration platform and customer implementations.

Senior People Business Partner serving as a strategic advisor to senior leaders, aligning people and business strategies. Responsibilities include organizational design, workforce planning, talent development, leadership coaching, people analytics, employee relations, culture transformation, change management, and collaboration with HR centers of excellence. The role requires managing HRIS data, resolving complex employee relations matters, mentoring HR colleagues, and influencing enterprise-wide HR frameworks and initiatives.

Lead the architecture and greenfield implementation of an enterprise Atlassian Cloud platform. Design Jira tenancy, workflows, permissions, security, governance, integrations, and regulated-data controls; lead consolidation migrations from multiple Jira instances; and architect Confluence, JSM, Atlassian Access, and AI capabilities. Establish standards, decision records, automation libraries, and reference architectures while mentoring platform architects and administrators across global teams.

Leads CMS-mandated RADV audits and coding quality initiatives for Medicare Advantage and Commercial health plans. Oversees audit strategy, regulatory compliance, workflows, performance, process improvement, cross-functional coordination, and departmental operations. Manages staff through hiring, development, performance evaluation, and resource allocation. Requires extensive risk adjustment and medical coding quality experience, payer-industry knowledge, CMS regulatory expertise, and relevant coding certification.

Designs, builds, and operates secure, scalable AWS and Azure cloud infrastructure across multi-account environments. Develops Infrastructure as Code, CI/CD pipelines, automation, observability, and IAM governance. Supports production reliability, incident response, FinOps, FedRAMP and HIPAA compliance, and AI-assisted engineering practices. Partners with product, security, and engineering teams to establish cloud standards, guardrails, and reference architectures.

Establishes and operates FinOps across AWS, Azure, GCP, and SaaS platforms. Responsibilities include cloud cost reporting, allocation, forecasting, chargeback/showback, tagging governance, anomaly investigation, optimization, savings-plan management, AI spend tracking, and executive reporting. Partners with Engineering, Finance, Procurement, Security, and vendors to improve cost transparency and governance during cloud migration and ongoing operations.

Owns the design, operation, resilience, security, and migration of HealthEdge’s hybrid cloud infrastructure across AWS, Azure, GCP, and on-premises environments. Responsibilities include Infrastructure as Code, disaster recovery, Kubernetes/EKS, IAM, server administration, CI/CD automation, monitoring, incident response, vulnerability management, compliance controls, cost governance, and technical documentation. The role participates in on-call support, leads infrastructure incident resolution, and guides teams on migration and recovery design.

Leads enterprise information security architecture strategy and design across network, application, data, identity, on-premises, hybrid, and cloud environments. Assesses risks, develops mitigation strategies, integrates advanced security technologies, automates security capabilities, and establishes identity and access management best practices. Influences stakeholders, drives organizational change, mentors technical teams, and ensures security initiatives align with business objectives and regulatory requirements.