Director, Configuration (EDI & Inbound Claims)

Role Description

Leads and directs team responsible for the delivery, execution and maintenance of products. Accountable for maximizing the value of assigned technical products that support enterprise operations. Leads the product vision, backlog, and delivery outcomes and serves as the primary bridge between business stakeholders and technical delivery teams. Ensures solutions align to business outcomes, regulatory requirements, and enterprise strategy, while partnering closely with engineering, architecture, data, QA, and operations teams on how solutions are delivered.

Job Duties

• Directs configuration team and demonstrates accountability for team performance - including meeting or exceeding established performance targets; targets may be based upon specific health plan requirements, and/or federal/state requirements.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals.
• Coordinates activities of assigned work function and/or department related activities ensuring efficiency and prioritization.
• Strategically plans, leads, and manages configuration workflow processes.
• Continuously identifies and executes opportunities for operational efficiencies and develops best practice approaches for assigned operational areas, ensuring achievement of organizational/department goals.
• Identifies appropriate resources are available to achieve department goals - escalates resource needs, rationale, and deficiencies to leadership.
• Ensures appropriate follow-up and communication occurs on direct assignments, and activities and tasks that fall within the scope of configuration.
• Ensures team compliance with applicable federal/state regulations and internal policies/procedures.
• Owns and communicates a clear product vision aligned to enterprise strategy and operational outcomes.
• Partners with business stakeholders to understand problems, desired outcomes, constraints, and regulatory obligations.
• Directs the development and implementation of contract, benefit configuration, and fee schedules.
• Directs the implementation and maintenance of member benefits in the claims payment system and other applicable systems.
• Supports critical business strategies by providing systematic solutions and/or recommendations on business processes.
• Plans for long-term success of the department and individual health plans - focusing on goals and improvements to daily operations.
• Builds and maintains strong trusted relationships with key stakeholders including health plan leadership and other cross-functional departments; presents data and opportunities to stakeholders and collaborates on performance improvement initiatives.
• Collaborates closely with engineering, architecture, data, QA, operations teams, and Health Plans to ensure solutions are feasible, scalable, and supportable.
• Partners with health plan, compliance, legal, and audit teams as needed to support reviews and implementations.
• Supports enterprise goals related to standardization and reduction of unmanaged complexity.
• Partners closely with stakeholders to clarify requirements and translate needs into backlog items.

Qualifications

• At least 8 years of experience in product ownership, product management, business analysis, or technical solution delivery.
• At least 3 years of management/leadership experience.
• Demonstrated experience working within Agile/Scrum delivery models.
• Experience supporting technical products such as enterprise platforms, configuration tools, data solutions, integrations, or operational systems.
• Strong understanding of software development lifecycles and Agile principles.
• Proven ability to write clear, testable user stories and acceptance criteria.
• Experience prioritizing work in complex, highly regulated environments.
• Strong analytical and problem-solving skills.
• Excellent communication skills with the ability to influence across technical and non-technical audiences.
• Ability to operate effectively in ambiguity and make decisions with incomplete information.

Requirements

• Prior Product Owner or Product Manager certification strongly preferred at time of hire.
• Experience with enterprise platforms, APIs, integrations, or configuration-heavy systems.
• Experience in healthcare, financial services, or other regulated industries.
• Familiarity with Agile tooling (e.g., Jira, Azure DevOps, Rally).
• Developing and writing SQL queries.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.