Medical Core System Transformation Lead I Dubai I Financial Services I Orient Insurance PJSC
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About the Role
The Medical Core System Transformation Lead is responsible for end‑to‑end delivery of the health insurer’s core medical system modernization, including policy administration, claims, benefits, provider management, and clinical integrations.
Key Skills for This Role
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Job Description
The Medical Core System Transformation Lead is responsible for end‑to‑end delivery of the health insurer’s core medical system modernization , including policy administration, claims, benefits, provider management, and clinical integrations.
This role owns the business-led transformation of legacy medical systems into a modern, scalable, compliant, and digital-first platform that enables operational efficiency, better member and provider experience, regulatory compliance, and future AI/analytics capabilities.
1. Transformation Leadership
- Lead the strategy, design, and execution of the medical core system transformation program.
- Act as the single point of accountability for business outcomes, timeline, and value realization.
- Translate enterprise strategy into a clear transformation roadmap (phased migration, MVPs, decommissioning).
2. Core Medical Systems Ownership
- Own transformation across key medical domains, including:
- Claims adjudication and payment
- Policy & benefits configuration
- Provider and network management
- Authorizations and utilization management
- Medical pricing, rules, and payment logic
- Drive modernization from monolithic/legacy platforms to configurable, API-driven core solutions.
3. Business & Clinical Alignment
- Partner with Medical, Operations, Finance, Actuarial, Compliance, and Provider Relations teams.
- Ensure business rules, clinical workflows, and regulatory requirements are accurately digitized.
- Resolve trade-offs between standard product capability vs. local customization.
4. Vendor & Partner Management
- Lead engagement with core system vendors, system integrators, and niche solution providers.
- Oversee solution design, deployment quality, and contractual commitments.
- Govern vendor delivery to ensure alignment with architecture, security, and compliance standards.
5. Governance & Delivery Execution
- Establish strong program governance , including milestones, dependencies, and risks.
- Manage multi-workstream delivery (technology, data, business readiness, migration, change).
- Ensure transformation is delivered with minimal disruption to ongoing business operations.
6. Regulatory & Compliance Readiness
- Ensure core systems meet health insurance regulatory, payer, and data privacy requirements.
- Support audits, reporting, and compliance validation through system design and controls.
7. Change, Adoption & Value Realization
- Drive business adoption through process redesign, training, and change management.
- Define and track value realization metrics (speed, cost, accuracy, scalability).
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