PROGRAM MANAGER, HEALTH PLAN DATA SUBMISSIONS

Vatica Health / Cozeva

Role summary: Own the end-to-end execution and continuous improvement of HPDE, Bridge/PayerOne, and DAV outbound data programs, ensuring accurate, timely, audit-ready delivery through disciplined planning, technical fluency, proactive risk management, and effective customer and cross-functional leadership.

Role Overview The Program Manager, Health Plan Data Submissions is the operational owner and central point of accountability for the Health Plan Data Submissions portfolio, including HPDE, Bridge/PayerOne, and DAV outbound delivery. This role is responsible for translating complex technical and business requirements into executable plans, maintaining accurate program status, leading cross-functional delivery activities, and ensuring customer questions and escalations are driven to resolution.

The Program

Manager also turns recurring delivery issues and customer feedback into sustainable product, process, documentation, and automation improvements.

The role requires a technically capable, confident, appropriately persistent, and self-directed leader who can operate effectively in a fast-paced, highly regulated environment.

The Program

Manager must independently identify risks, ask probing questions, challenge unclear or inconsistent information constructively, maintain a reliable system of record, and drive action across Engineering, Technology Services, Operations, Customer Success, Product, and other stakeholders. Success requires detailed operational execution, intellectual curiosity, sound judgment, and confident customer-facing communication.

Work Schedule and Availability: This role supports customers and internal teams operating primarily during U.S. business hours. The employee is expected to maintain a work schedule that overlaps with at least 50% of standard U.S. Pacific Time working hours and to be available for customer, leadership, and cross-functional meetings outside the employees regular schedule when reasonably required to support delivery timelines, customer needs, or issue resolution.

Core Accountabilities

- Own the end-to-end lifecycle for HPDE, Bridge/PayerOne, and DAV outbound submissions, from intake and requirements clarification through file generation, validation, delivery, confirmation, issue resolution, and year-end closeout.
- Serve as the primary operational point of contact for the assigned portfolio and independently respond to or coordinate resolution of customer inquiries, delivery questions, defects, and escalations.
- Maintain a complete and current understanding of which health plans receive each file type, applicable year-round and end-of-year delivery cadence, customer-specific exceptions, deduplication rules, cutoffs, dependencies, and validation requirements.
- Create and maintain accurate, centralized trackers, Redmine tickets, roadmaps, decision logs, status reports, delivery confirmations, and supporting documentation as the authoritative source of truth.
- Build and maintain an accessible internal knowledge base of procedures, requirements, customer-specific decisions, escalation paths, FAQs, and reusable communication guidance to support consistent execution and onboarding.
- Lead recurring program and Engineering working sessions by preparing the agenda, presenting current tracker and ticket status, asking clarifying and probing questions, documenting decisions and action items, and driving follow-up to closure.
- Proactively identify delivery risks, conflicting requirements, documentation gaps, blocked dependencies, and inaccurate or stale status information before they create customer or operational impact.
- Translate technical file-generation, transformation, validation, SFTP, CCD/FHIR, deduplication,



and delivery concepts into transparent business plans and customer-ready explanations.
- Coordinate cross-functional teams to establish clear ownership, realistic timelines, control points, QA gates, and escalation paths for every submission cycle.
- Ensure customer communications are accurate, concise, appropriately coordinated with Customer Success and leadership, and completed within required timelines.
- Drive continuous improvement by identifying repeatable workflows and root causes of rework; prioritizing opportunities for automation, pre-output validation controls, SOP enhancements, and training; and confirming that corrective actions reduce recurrence.

Technical and Operational Responsibilities

- Develop and maintain submission-cycle execution plans by health plan, including file types, delivery cadence, deadlines, end-of-year activities, known exceptions, dependencies, and unresolved gaps.
- Understand and validate outbound workflows from ingestion through transformation, file generation, QA, delivery, and downstream confirmation.
- Maintain working knowledge of DAV, HPDE, PayerOne/Bridge, NSSD/SSD distinctions, year-to-date versus incremental delivery approaches, end-of-year removal or backout logic, and customer-specific file requirements.
- Review and reconcile tracker status against Redmine tickets, Engineering updates, customer decisions, and current scope to prevent duplicate, contradictory, or descoped work.
- Partner with Engineering and Technology Services to assess technical feasibility, clarify defects versus enhancements, evaluate dependencies, and drive timely resolution of file or delivery issues.
- Define and enforce standardized intake requirements, naming conventions, file specifications, status tracking, delivery triggers, validation checkpoints, and audit-ready documentation.
- Use data, customer feedback, and operational evidence to identify trends, recurring defects, missed handoffs, re-generation causes, and product or process-control opportunities; establish clear owners and timelines for agreed improvements.
- Perform or support structured analysis of submission, validation, and delivery data to reconcile counts, identify anomalies, investigate variances, validate assumptions, and provide evidence-based recommendations to technical, operational, and customer-facing stakeholders.
- Independently obtain, understand, and effectively use the access, tools, documentation, and historical decisions needed to perform the role.

Leadership, Communication, and Customer Responsibilities

- Operate with urgency and confidence; act without waiting for routine direction when requirements, owners, or next steps are reasonably clear.
- Ask specific, informed questions when requirements are incomplete or inconsistent and continue follow-up until the issue is resolved or formally escalated.
- Provide concise, accurate portfolio-level status updates that clearly identify completed work, upcoming deadlines, open risks, decisions needed, owners, and mitigation actions.
- Build strong working relationships across Engineering, Technology Services, Operations, Product, Customer Success, Quality Programs, and client-facing teams.
- Facilitate customer and internal meetings with clear objectives, current documentation, informed recommendations, and documented next steps.




- Communicate directly and professionally with customers, including explaining technical delivery issues in understandable terms and coordinating timely resolution.
- Partner with Product, Customer Success, Engineering, and Operations to develop customer-facing submission guidance, FAQs, and reusable explanations that improve self-service and reduce recurring questions.
- Escalate risks early with a clear statement of impact, options, recommendation, accountable owner, and required decision date.
- Demonstrate sound judgment regarding when to act independently, when to coordinate with subject matter experts, and when leadership approval is required.

Required Qualifications

- Bachelor's degree or equivalent practical experience.
- 5+ years of progressive experience in program management, technical operations, implementation, data delivery, or a related role supporting complex, deadline-driven programs.
- Demonstrated success independently owning a multi-workstream program with fixed deadlines, technical dependencies, customer-facing responsibilities, and cross-functional stakeholders.
- Ability to understand complex data workflows, file formats, transformation logic, validation processes, system dependencies, and technical defects sufficiently to lead execution and ask informed questions.
- Proven ability to maintain accurate operational systems of record, including trackers, tickets, action logs, delivery calendars, decision records, and status reporting.
- Strong analytical and problem-solving skills, including the ability to identify inconsistencies, assess impact, determine root cause, and recommend a path forward.
- Ability to interpret structured datasets, validation results, file-level metrics, and operational reporting; reconcile information across multiple sources; and translate findings into clear conclusions and actions.
- Excellent written and verbal communication skills with the ability to communicate effectively with customers, executives, technical teams, and operational stakeholders.
- Demonstrated self-direction, initiative, intellectual curiosity, follow-through, learning agility, and the ability to manage multiple concurrent priorities while maintaining reliable execution.
- Ability to lead meetings, challenge assumptions respectfully, hold stakeholders accountable, and drive decisions and action items to closure.
- High attention to detail and commitment to data accuracy, documentation integrity, and audit readiness.
- Ability and willingness to maintain at least 50% overlap with standard U.S. Pacific Time working hours and to participate in customer and internal meetings as reasonably required to support program delivery, escalations, and time-sensitive issues.

Preferred Qualifications

- Experience in healthcare data exchange, quality reporting, HEDIS, payer data operations, or regulated healthcare environments.
- Program Manager, Health Plan Data Submissions | Revised July 2026
- Experience with HPDE, DAV, Bridge/PayerOne, supplemental data, CCD/FHIR, SFTP workflows, or other health plan submission processes.
- Experience partnering directly with software engineering, data engineering, validation, configuration, and delivery teams.
- Experience with Redmine, Jira, or comparable ticketing systems; structured program trackers; and documentation platforms such as Notion or Confluence.
- Working knowledge of data-analysis tools and methods, such as advanced Excel, SQL, data reconciliation, data-quality validation, trend analysis, and dashboard or reporting tools such as Power BI or Tableau.
- Experience supporting audit-sensitive, compliance-driven, or non-negotiable regulatory deliverables.
- Experience developing SOPs, process maps, QA controls, customer education materials, and operational training.

📌 Program Manager, Health PLAN DATA Submissions (Kolkata)
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