Seeking a hands-on healthcare applications leader with experience in claims systems, payer operations, Unix/AIX, COBOL, integrations, and healthcare configuration. Ideal candidate enjoys solving technical problems, mentoring teams, and is interested in growing into broader people leadership over time.
General Description
Responsible for leading the design, modernization, integration, and technical delivery of HPSM’s core payer applications. This role serves as a hands-on technical leader responsible for application architecture, complex integrations, automation, data flows, and system reliability across benefits, claims, authorizations, and provider systems.
Qualifications
The following represents the typical way to achieve the necessary skills, knowledge, and ability to qualify for this position:
Education and Experience
- Bachelor’s degree in computer science or related field, five (5) to seven (7) years of information technology management experience in a healthcare environment, and two (2) to four (4) years of management experience preferred.
- An equivalent combination of education and experience may be considered.
Skills
- Advanced skills in project and program management.
- Advanced skills in leading change control, release management, test planning, and implementation coordination.
- Intermediate skills in service management fundamentals, including SLA/OLA management and incident/problem response.
- Advanced Microsoft Office Suite applications skills, (e.g., Outlook, Word, Excel, Teams, Visio, and PowerPoint.
Knowledge
- Extensive knowledge of core health plan operations and payer functions (benefits/eligibility, claims, encounters, authorizations, provider configuration) and how application decisions impact downstream reporting and finance.
- Extensive knowledge of security, privacy, and compliance, including protected health information (PHI) protection and access/audit controls.
- Extensive knowledge of people leadership fundamentals for a technical team.
- Working knowledge of healthcare data exchange standards (including HIPAA/X12 EDI) and supporting vendor, provider, and partner integrations.
- Working knowledge of application configuration and technical fundamentals, including relational databases/SQL, data flows, interfaces, and practical automation/scripting to support team efficiency.
- Working knowledge of vendor-supported systems and vendor management, including requirements definition, issue escalation, and coordinating fixes and enhancements.
Abilities
- Ability to translate business needs into actionable technical work, communicate tradeoffs, and align stakeholders on scope, timelines, and outcomes.
- Demonstrated ability to analyze and troubleshoot complex application, data, and integration issues, driving root-cause resolution and stability improvements.
- Demonstrated ability to enforce disciplined change/release, testing, documentation, and operational readiness practices.
- Ability to identify and implement process improvements and automation to increase efficiency, reduce manual effort, and improve data quality.
Licensure/Certifications
Driving
Duties & Responsibilities
Essential Functions
Leading People
- Develop, manage, and lead a team of self-accountable professionals by modeling real, personal accountability and instilling a culture of psychological safety and accountability.
- Support direct reports in holding themselves accountable to high performance standards and professional conduct in a clear, helpful, straightforward way.
- Conduct one-on-one conversations with direct report(s), focused on performance, development, and career growth.
- Ensure compliance with labor laws/regulations, support the implementation of organizational policies and procedures, and foster a positive and inclusive culture.
- Support the development, implementation, and monitoring of the department budget, to ensure efficient resource allocation and compliance with policies.
Delivering Results
- Set clear priorities, timelines, and ownership across support and project work.
- Proactively remove blockers and manage risks to ensure stable production and workflow.
- Utilize metrics and insights to minimize recurring issues and enhance system reliability.
- Direct team efforts to balance support demand with planned initiatives and strategically allocate resources to high-priority objectives.
Leading Change
- Champion improvements in workflows, reduce manual effort, and improve service quality.
- Guide the team through change with clear expectations, training, and practical documentation.
- Promote continuous learning and cross-training to reduce single points of failure.
- Lead the modernization of applications and integrations to better support business needs.
- Collaborate on organization-wide projects to improve operational efficiency and effectiveness.
Building Coalitions
- Build strong partnerships with business and IT peers to align priorities and deliver outcomes.
- Coordinate effectively with vendors and external partners, set expectations, and manage escalations to resolution.
- Communicate effectively across technical and non-technical audiences to keep stakeholders informed and engaged.
- Foster trust through transparency, follow-through, and constructive issue resolution.
Secondary Functions
- Provide coverage and escalation support as needed to ensure continuity of operations.
- Adhere to work performance norms and attendance expectations.
- Perform other duties as assigned.
The Health Plan of San Mateo (HPSM) is an equal opportunity employer and is committed to providing equal employment opportunities to all applicants and employees without regard to race, color, religion, creed, political affiliation, sex, gender, gender identity or expression, pregnancy, childbirth and related medical conditions, marital status, registered domestic partner status, sexual orientation, age, ancestry, national origin, citizenship status, veteran or military status, disability, medical condition, genetic information, or any other characteristic protected by applicable federal, state, or local law.
This policy applies to all aspects of employment, including recruitment, hiring, selection, placement, promotion, transfer, demotion, compensation, benefits, training, discipline, and termination.
HPSM is committed to providing reasonable accommodations to qualified individuals with disabilities and to applicants and employees with sincerely held religious beliefs or practices, in accordance with applicable law. If you require an accommodation during the application or interview process, or in order to perform the essential functions of a position, please contact the HPSM recruiter to request assistance.
