Sr. Project Manager - Health Insurance

Responsibilities

• Use program and project management experience, training, and skills to run successful projects within a Health Insurance Organization.
• Proven Expertise in many operational areas within a health insurance organization, including claims, billing, provider, enrollment, pharmacy, fulfillment, quality, etc.
• Engage with multiple stakeholders at all levels of the organization, including executives, directors, managers, and individual contributors.
• Work with project sponsor(s) and leader(s) to perform planning, including budget and hardware/software estimates, resource estimates and procurement, and implementation timelines for new implementations or enhancements.
• Collaborate with project sponsor(s) and leader(s) to manage and monitor vendor resources and task assignments as needed.
• Develop and manage a project schedule throughout the project life cycle, from initiation through post-implementation.
• Apply formal Change Management processes when substantive modifications affecting the project scope, timeline, or resources/budget are suggested or necessary.
• Manage project resources, ensure appropriate allocation, alignment to tasks, adherence to the timeline, and conflict resolution.
• Ensure the project team provides high-quality and cost-effective analytical support services.
• Facilitate and/or lead process improvement discussions and ensure that current state, desired state, and gaps are well-documented for development of recommendations.
• Facilitate issue resolution through analysis and collaboration; develop and present recommendations to leadership and negotiate to reach a resolution.
• Identifies, evaluates, prioritizes, and manages project risks through the application of a Risk Management process designed to minimize, monitor, and control the impact of risks to the project.
• Organizes and synthesizes large amounts of information for presentation to project sponsor(s), leader(s), and team members through meetings and formal status reporting.
• Sure all necessary information is supplied to the Quality Assurance Team for suitable planning and execution of testing.
• Sure all necessary information is supplied to the Training Team for planning and execution of staff training.
• Writes or oversees writing of applicable project documents including project charters, project plan, project schedule, policy and procedures, RACI/project log, business requirements, policies and procedures, and training materials using standard and approved documentation templates. Ensure all project documents are complete, accurate, current, and stored appropriately.
• Plan, schedule, and facilitate project meetings as needed to effectively manage the project tasks and resources.
• Develops and publishes detailed implementation plans and schedules.
• Supports post-implementation stabilization and project closure activities.

Qualifications

• Proven success in multiple project implementations within a health insurance company in claims, billing, provider, enrollment, pharmacy, fulfillment, quality, etc., operational areas.
• Able to manage and participate in more than one project of a reasonable size simultaneously.
• Able to understand and impartially consider project needs among diverse colleagues in various departments of the same organization.
• Able to produce accurate and precise work, detect and resolve discrepancies, all while meeting deadlines.
• History of exemplary relationship management and effective communication with project sponsors, leaders, and team members from across the healthcare organization.
• Proficiency with MS Office Suite (Outlook, Word, Excel, PowerPoint), MS Project, and Visio required. Proficiency with SharePoint, Access, and SQL preferred.
• Familiarity with various project methodologies (Waterfall, Agile, SAFe, Hybrid).
• Experience with Epic Tapestry and/or Health Rules Payor claims system and Guiding Care care management systems is a must.
• Experience in Medicare Advantage products, Medicaid products and ACA/Healthcare Exchange products is a must.
• Bachelor’s degree in healthcare administration or related field. Four (4) years of experience managing projects within a health care organization may be considered in lieu of a bachelor’s degree.
• Health Plan operations expertise in claims, billing, provider, enrollment, pharmacy, fulfillment, quality, etc.
• Five (5) years of experience working within a medical health care (insurance) organization is required.
• Three (3) years of experience managing one or more phases of a small- to medium-sized project involving a minimum of five (5) cross-functional team members in a matrixed health care organization or closely related industry.
• PMP, PgMP, Scrum Master, Six Sigma Belt certification preferred.
• Experience in Epic Tapestry or Health Rules Payor and/or Guiding Care systems.
• Experience in Medicare Advantage, Medicaid, and ACA/Healthcare Exchange Products.