Executive Healthcare Claims Consultant

Job Summary

Leading a large-scale healthcare administration transformation, the remote Executive Healthcare Claims Transformation Consultant will manage the migration from Harvard Pilgrim health plan administration processes to Aetna-based operations, ensuring claims integrity and operational continuity while collaborating with executive leadership and cross-functional teams.

Key responsibilities

• Lead end-to-end planning and execution of healthcare administration and claims platform implementation
• Ensure continuity of claims processing and member/provider experience during the transition
• Develop and execute enterprise implementation roadmaps, governance structures, and risk management frameworks

Required qualifications

• 8+ years of progressive leadership experience in healthcare plan domains, with specific expertise in Aetna
• Deep subject matter expertise in healthcare claims systems and payer operations
• Demonstrated success in leading large-scale healthcare administration or claims transformation programs
• Strong knowledge of regulatory and compliance requirements
• Proven ability to communicate and collaborate with executive leadership