Here is the job description for your review:

Role: Capability Manager

Job Type: Contract

Location: Remote

Job Description:

Capability Manager, Trial Claim is responsible for defining, managing, and delivering enterprise trial claim capabilities across multiple claim adjudication engines. This role manages cross-functional initiatives spanning key trial claim intents, including prior authorization responses, benefit responses, and cost estimates across provider and consumer experiences. The position also oversees root cause analysis and accuracy management for the supported claim adjudication engines.

What is the break-down of candidate skill sets?

• Critical thinking to define project scope and objectives

• Experience writing business and/or system requirements

• Tracking and planning projects from discovery through execution

• Effective communication with an audience ranging from entry level to executive leadership
• Create and manage project work in Aha!

• Intermediate MS Office application skills (Word, Excel, PowerPoint)

What are the top 5-10 responsibilities for this position (please be detailed as to what the candidate is expected to do or complete on a daily basis)?

• Support capability vision, strategy, priorities, and roadmap by engaging enterprise stakeholders to enable awareness and alignment

• Demonstrate a deep understanding of relevant business and/or product strategies

• Define capabilities and lead functionality reviews through acceptance

• Partner with stakeholders to gather, document, and groom business requirements; enable prioritization, development, delivery, and adoption of capabilities using the defined development process

• Report capability health in a timely and accurate manner

• Mitigate, manage, and resolve risks and issues associated with capability delivery

• Demonstrate awareness of defined business value

• Support initiative issue resolution

• Own defect management, root cause and remediation, including tracking along side business and IT stakeholders

• Serve as the capability champion, representing the capability and engaging business and IT stakeholders to achieve business objectives and expectations

• Track and manage financials across capability delivery, including impacted applications, cost estimates, funding alignment, and ongoing spend to ensure transparency and informed prioritization

What does the ideal candidate background look like (ex: healthcare specific background specific industry experience etc.)?

• 3+ years of claims experience

• 3+ years of experience in business operations, capability management, or product ownership, including strategy development, planning, project management, solution design, collaboration, and dependency management

• 3+ years of experience defining business requirements in partnership with business and technology teams

What skills/attributes are required (please be detailed as to number of years of experience for each skill)?

• 3+ years of experience working with healthcare claims (i.e., operations, strategy, planning, or technology)

• 5+ years of experience in writing business and/or system requirements, including gathering requirements for enhancements, interfaces, and data mapping

• 3+ years of experience in tracking and planning projects

• 3+ years of matrixed leadership experience with matrixed cross functional / cross segment teams experience / cross discipline

• Proven ability to work under pressure and meet tight deadlines

What skills/attributes are preferred (what will set a candidate apart)?

• Product experience such as Aha! or Rally

• Demonstrated enterprise perspective, with the ability to connect priorities, identify interdependencies, and align plans to achieve business goals

• Experience in project planning, tracking, and coordination

• Strong executive presence and ability to communicate effectively with senior leaders

• Proven ability to build and sustain strong relationships across the organization

• Strong verbal, written, interpersonal, and presentation skills

• Experience working effectively in a matrixed environment

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