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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Technical Project Management with a focus on ClaimsCore modernization, systems integration, and data migration within the healthcare sector. Proven ability to lead multidisciplinary teams, manage complex technical initiatives, and communicate effectively with diverse stakeholders.
Highest-signal resume keywords
Technical Project ManagementSystems IntegrationData MigrationHealthcare Payer ExperiencePMP Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
API IntegrationEDIData MappingIntegration TestingOperational ReadinessDependency MappingError HandlingReconciliationProduction CutoverInterface Planning
Soft Skills
Effective CommunicationLeadershipProblem SolvingTeam CoordinationAdaptability
Tools & Technologies
TriZetto FacetsAWSHybrid-Cloud ArchitecturesCMS Shared ServicesX12 Healthcare Transactions
Certifications & Qualifications
PMPSAFeAgile
Industry Keywords
CMSMedicareClaims ProcessingHealthcare ModernizationFederal Healthcare Programs
Tech Stack
Tools & technologiesAWSCloudPMP
About the role
Key responsibilities & impact- Support the CMS ClaimsCore modernization program as an experienced Technical Project Manager
- Provide technical leadership across ClaimsCore integration, migration, interface planning, and claims-processing activities
- Lead complex technical initiatives involving systems integration, data migration, claims-processing capabilities, and Medicare shared services
- Develop and manage integrated implementation plans covering interfaces, data flows, configuration, testing, operational readiness, and production transition
- Coordinate technical activities across application development, integration, infrastructure, security, data, testing, and business teams
- Lead interface discovery and planning, including current-state analysis, requirements, ICD/specification development, testing, certification, cutover, and production readiness
- Work with CMS, MACs, and SMEs to understand beneficiary, eligibility, provider, claims history, claim-status, adjudication, and pricing/editing dependencies
- Lead data migration activities including source-system analysis, mapping, transformation, reconciliation, historical-data use, data quality, and migration validation
- Coordinate implementation planning with ClaimsCore adjudication services and CMS shared services
- Resolve cross-team dependencies, technical issues, architectural decisions, risks, and implementation blockers
- Develop executive-level status updates, recommendations, risk assessments, and implementation-readiness materials
- Support MAC onboarding, phased implementation waves, cutover, operational readiness, and stabilization
- Define measurable entry/exit criteria and completion evidence for major implementation milestones
- Facilitate technical working sessions and translate discussions into clear decisions and accountable actions
- Lead multidisciplinary teams and assume responsibility for a major ClaimsCore production workstream
Requirements
What you’ll need- Bachelor’s degree in IT, Computer Science, Engineering, Healthcare Administration, Business, or related field; equivalent relevant experience considered
- 12+ years of progressively responsible technical project/program management experience in enterprise systems implementation
- Experience leading large-scale systems-integration initiatives involving APIs, EDI, batch/file, databases, or multi-system connectivity
- Experience leading or coordinating large data migrations involving mission-critical systems
- Healthcare payer or claims-processing experience, preferably with institutional and professional claims
- Strong understanding of enterprise architectures, interfaces, ICDs/specifications, system dependencies, integration testing, and production cutover
- Experience with interface inventories, dependency mapping, source-to-target data mapping, error-handling approaches, reconciliation, and operational support models
- Experience managing multidisciplinary technical teams and coordinating with infrastructure, application, business, and vendor stakeholders
- Experience developing integrated schedules, risk registers, dependency matrices, and executive-level reporting
- Ability to communicate effectively with engineers, architects, SMEs, executives, government customers, and external partners
- Ability to lead teams through ambiguity and develop actionable plans when requirements are evolving
- Ability to obtain a Public Trust
- US Citizen or a Green Card Holder
- Experience with Medicare Administrative Contractors and MAC operational dependencies preferred
- Direct CMS or Medicare Fee-for-Service experience preferred
- Knowledge of CMS shared services such as CWF, PECOS, HIGLAS, pricing/editing services, eligibility/beneficiary services, claim-status services, and related interfaces preferred
- Experience with TriZetto Facets integrations or implementations preferred
- Experience migrating from legacy claims-processing systems to modern platforms preferred
- Experience with X12 healthcare transactions including 837, 835, 270/271, and 276/277 preferred
- Experience with API-led, hybrid-cloud, or AWS-based integration architectures preferred
- Experience supporting or leading production deployments, phased migrations, MAC onboarding, and post-implementation stabilization preferred
- PMP, SAFe, Agile, or similar program-management certification preferred
- Experience in large federal healthcare modernization programs preferred
Benefits
Comp & perks- Employees may be eligible for overtime
- Shift differential may be available
- Discretionary bonus may be available
- Equal opportunity employment, including disability and protected veterans