Information Technology - Manager Core Administrative Systems 130-2055 at CommunityCare

Tulsa, Oklahoma, United States -

Full Time

Start Date

Immediate

Expiry Date

07 Feb, 26

Salary

0.0

Posted On

09 Nov, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Core Payer Operations, Integration Methods, Vendor Management, Project Management, Problem-Solving, Analytical Skills, Communication Skills, Cross-Functional Leadership, EDI Transactions, Claims Processing, Data Integration, System Administration, Technical Support, HIPAA Compliance, API Design, Data Accuracy, Performance Monitoring

Industry

Insurance

Description

JOB SUMMARY: The Manager, Core Administrative Systems will oversee the strategy, operations, and support of the health plan’s CAPS platform, with a strong focus on managing the migration of legacy systems to new CAPS environments. This role will sit within the IT department and will serve as the primary liaison between IT, business operations, and vendor partners to ensure seamless system integration, data flow, and ongoing operational support. The Manager will provide technical leadership in system administration, coordinate data integration projects, and ensure the health plan’s core processing environment supports accurate claims adjudication, enrollment, billing, and provider management. KEY RESPONSIBILITIES: Leads the migration of CAPS platforms from legacy systems to modernized solutions, ensuring minimal disruption to operations. Develops and manages migration roadmaps, testing strategies, cutover planning, and post-implementation validation. Collaborates with vendors, consultants, and internal stakeholders to execute system conversions, data mapping, and reconciliation. Oversees data integrations between CAPS and related enterprise systems (EDI gateways, provider portals, CRM, finance, etc.). Ensures HIPAA-compliant handling of PHI and PII in all integrations and workflows. Partners with IT development and data teams to design, test, and maintain API, HL7, X12, and custom integrations. Monitors data accuracy and integrity, implementing processes to identify and resolve discrepancies. Provides Tier-2/3 technical support for CAPS issues and escalates with vendors as needed. Manages production incidents, system outages, and root-cause analysis to prevent recurrence. Develops and enforces IT operational procedures, including change management, release management, and patch schedules. Establishes performance monitoring and reporting to track uptime, processing speeds, and error rates. Supervises CAPS analysts and technical staff as applicable. Acts as a subject matter expert (SME) for CAPS within IT and cross-functional business teams. Collaborates with operations, claims, enrollment, provider relations, and compliance departments to ensure system functionality aligns with regulatory and business needs. Builds strong vendor partnerships and manage service level agreements (SLAs). Performs other duties as assigned. QUALIFICATIONS: Deep understanding of core payer operations (claims, eligibility, billing, authorizations, provider data). Strong knowledge of integration methods (APIs, HL7, X12, ETL). Familiarity with Medicare Advantage, Medicaid, and commercial lines of business a plus. Strong vendor management and project management skills. Excellent problem-solving, analytical, and communication abilities. Demonstrated ability to lead cross-functional initiatives in a fast-paced environment. Possess strong oral and written communication skills. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: Bachelor’s degree in Information Systems, Computer Science, or related field (Master’s preferred). 7+ years of IT experience in health insurance or healthcare payer systems, with at least 3 years in CAPS management. Proven experience with CAPS migration or system conversion projects. Hands-on experience with EDI transactions (X12 837/835/834/820), provider data management, and claims processing systems. CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Responsibilities

The Manager will oversee the strategy, operations, and support of the health plan’s CAPS platform, focusing on migrating legacy systems to new environments. This role involves collaborating with various stakeholders to ensure seamless system integration and ongoing operational support.