Job Description

LRS Consulting Services is seeking an experienced Executive Healthcare Claims Transformation Consultant for a remote consulting opportunity with our healthcare client in the Chicago metro area!

LRS has prospered for over 30 years because our corporate philosophy embraces honest, ethical and hard-working people. If that describes your approach to IT consulting, we need to talk!

This individual will lead a large-scale enterprise healthcare administration transformation involving the migration from Harvard Pilgrim health plan administration processes to Aetna-based administration and claims operations. They will serve as the strategic leader responsible for planning, governing, and executing all aspects of the transition, while partnering directly with executive leadership, operational teams, and vendor partners. As well as leveraging expertise in healthcare claims administration, payer operations, health plan implementation, enterprise transformation programs, and executive stakeholder management. This is a highly visible consulting engagement responsible for ensuring successful migration, operational continuity, claims integrity, regulatory compliance, and executive-level governance throughout the transformation lifecycle.

Responsibilities

• Lead end-to-end planning and execution of a healthcare administration and claims platform implementation. Including migration of healthcare claims operations from Harvard Pilgrim administration processes to Aetna-aligned operational models.
• Ensure continuity of claims processing and member/provider experience throughout implementation, specifically across dual-claims systems operating environments.
• Develop and execute enterprise implementation roadmaps, governance structures, risk management frameworks, and transformation strategies.
• Serve as trusted advisor to C-suite executives and executive leadership teams.
• Present program status, risks, mitigation strategies, and transformation outcomes to executive-level audiences.
• Collaborate with cross-functional teams spanning operations, technology, claims administration, enrollment, finance, customer service, compliance, and vendor organizations.
• Author creation of a comprehensive enterprise transformation runbook supporting implementation, cutover, stabilization, and long-term operations.
• Drive program execution across all stages
• Manage relationships with Aetna, third-party administrators, technology vendors, consulting partners, and internal business units.
• Negotiate priorities, timelines, deliverables, and operational commitments across stakeholder groups.
• Drive accountability across multiple organizations and leadership teams.
• Other duties as assigned.

Required Qualifications

• 8+ years of progressive leadership experience in relevant healthcare plan domains, including deep experience with Aetna specifically
• Deep subject matter expertise in healthcare claims systems as well as healthcare payer operations &/or health plan administration
• Demonstrated success leading large-scale healthcare administration or claims transformation programs.
• Strong knowledge of regulatory and compliance requirements.
• Experience operating within dual-claims or parallel-processing environments preferred
• Proven ability to communicate and collaborate with executive leadership.
• Proven ability to develop enterprise level develop runbooks for large scale implementation projects.

The base hourly range for this contract position is $100 - 200 per hour, depending on experience. The range displayed reflects the minimum and maximum target for new hires of this position across all U.S. locations. Individual pay is determined by work location and additional job-related factors.

LRS is an equal opportunity employer. Applicants for employment will receive consideration without unlawful discrimination based on race, color, religion, creed, national origin, sex, age, disability, marital status, gender identity, domestic partner status, sexual orientation, genetic information, citizenship status or protected veteran status.

In some cases, Fulcrum Consulting, an LRS company uses generative artificial intelligence (“AI”) in support of our hiring processes. LRS takes steps to ensure the use of AI does not result in discrimination based on protected class(es). AI may be used in the hiring process solely in support of the assessment of candidate qualifications. All decisions in the hiring process are made by LRS employees. If AI will be used in the hiring process for the position for which you are applying, you will be notified and will have the opportunity to opt out. If you have any questions, please contact us by clicking here.