Health Plan Integration Principal

Job Summary

A company is looking for a Principal, Health Plan Integrations.

Key Responsibilities

• Act as a subject matter expert on health plan operations and manage cross-departmental workflows
• Lead integrations between health plan core systems and ensure data accuracy and usability
• Partner with stakeholders to configure eligibility, benefits, and claims rules, validating through testing and production readiness

Required Qualifications

• 8-10+ years of experience in health plan operations, healthcare IT, or healthcare implementations involving health plan integration
• Strong understanding of EDI transactions and healthcare data flows
• Experience with core health plan systems such as Facets, QNXT, or Epic Tapestry
• Ability to translate business and clinical requirements into technical integration specifications
• Hands-on experience with eligibility and enrollment processing, claims configuration, and medical management systems