Senior Director, Business Rule Modernization

GuideWell Source

. Set direction for business rule modernization goals aligned to the Core Admin Platform transformation, executive priorities, and adjudication accuracy criteria .

Posted 10/14/2026full-timeJacksonville • Florida • United StatesSenior💰 $152,000 - $247,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Expertise in business rules configuration and claims adjudication, with a strong focus on modernizing rule sets through low-code and AI-enabled automation. Proven ability to lead teams, manage projects, and ensure compliance with regulatory standards while driving efficiency and accuracy in adjudication processes.

Highest-signal resume keywords

Claims AdjudicationBusiness Rules ConfigurationLow-Code AutomationProject ManagementTeam Leadership

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Business Rules ManagementRules Engine ManagementAdjudication AccuracyRisk AssessmentProcess ImprovementData AnalysisSystem Development Life CycleRule ConfigurationGovernance FrameworksPerformance Measurement

Soft Skills

Strategic ThinkingOrganizational SkillsCommunication SkillsCritical ThinkingInfluencing Skills

Tools & Technologies

AI-Enabled SolutionsLow-Code PlatformsRules Registry SystemsGovernance ToolsAudit Tools

Industry Keywords

Claims ProcessingRegulatory ComplianceAdjudication SystemsBusiness Process ManagementRisk Management

About the role

Key responsibilities & impact

Set direction for business rule modernization goals aligned to the Core Admin Platform transformation, executive priorities, and adjudication accuracy criteria
Lead continuous assessment of adjudication business rules across all lines of business
Centralize a single rules registry and inventory across five platforms with fragmented rule logic
Audit current rule configurations for accuracy, redundancy, and conflict with IT partners
Document clear business ownership for each rule
Prioritize rule gaps by risk, cost, member impact, and provider impact
Direct design and implementation of modernized rule configurations
Lead rules rationalization initiatives that consolidate fragmented logic into a single governed source
Identify and implement low-code and AI-enabled opportunities to automate rule configuration and maintenance
Develop shared goals and joint accountability with business units and IT
Establish ongoing governance and controllership to sustain rule accuracy and performance
Measure and report on efficiency and accuracy of adjudication-rule systems and processes
Flag drift and emerging risk for correction
Ensure monitoring capabilities provide accuracy and auditability consistent with corporate policy, regulatory standards, and accrediting criteria
Serve as liaison between senior business leaders and the enabling technical team
Align programs with the enterprise AI Coalition strategy
Direct a team of Senior Consultants

Requirements

What you’ll need

10+ years related work experience, including direct experience with claims adjudication, business rules configuration, or rules engine management
Proficient subject matter knowledge of business rules governing claims adjudication, including rule configuration, rules engines, and downstream code management
Demonstrated ability to apply a structured methodology, such as Assess, Improve, and Monitor, to evaluate and modernize complex rule sets
Demonstrated experience identifying and implementing low-code and AI-enabled automation to reduce manual configuration and reconciliation
Strategic thinking and planning abilities, with proven organizational skills and ability to work with ambiguity
Excellent written and verbal communication skills
High critical thinking skills to evaluate alternatives and present solutions consistent with business objectives and strategy
Demonstrated experience with project management concepts, theories, and processes
Demonstrated ability to manage people, financial resources, and information
Ability to establish, implement, and manage effective work processes and organizational structure
Ability to provide input to and influence business plans and strategies
Knowledge of the system development life cycle
5+ years direct supervisory/management experience
Bachelor’s degree or additional related equivalent work experience
Must be able to travel to multiple locations for work

Benefits

Comp & perks

Medical, dental, vision, life and global travel health insurance
Short- and long-term disability programs
Leave programs to support personal circumstances
Retirement Savings Plan including employer match
Paid time off
Volunteer time off
10 holidays
2 well-being days
Additional voluntary benefits
Comprehensive wellness program
Opportunities for incentive or commission compensation
Annual pay-for-performance reviews with potential base pay increases