Payment Integrity Specialist – Strategic Initiatives
About The Position
The Senior Business Process Consultant leads business case development for proposed initiatives, supports strategic planning, and leads larger-scale, cross-functional initiatives. The role ensures opportunities, risks, and return on investment are adequately assessed, and that initiatives support the strategic business plan, meet business objectives, and are effectively executed. Approved business cases are transitioned into initiatives with appropriate documentation and clear responsibilities. The position provides strategic and policy guidance for assigned initiatives and leads teams through project planning, analysis, facilitation, consensus building, recommendations, and implementation oversight. It analyzes data, workflows, policies, procedures, staff organization, and skills to support initiative execution. The role also supports project leaders, communicates process improvement initiatives across the organization, and provides other support to improve business performance. Other duties may be assigned, and the role must comply with all policies and standards.
Requirements
- Bachelor’s degree in a related field or equivalent experience.
- At least 6 years of project management experience.
- Certified Project Management Professional (PMP) from PMI required.
Nice To Haves
- Master’s degree in a related field.
- Experience in healthcare and/or insurance.
- Process quality certification.
- PMP certification preferred for Health Net and Enterprise Business Operations only.
Responsibilities
- Lead business case development for proposed initiatives, assessing opportunities, risks, and return on investment.
- Support planning and prioritization of initiatives within strategic and business planning processes.
- Ensure initiatives align with the strategic business plan, meet business objectives, and are tactically executed.
- Transition approved business cases into initiatives, including documentation and assignment of clear responsibilities.
- Lead larger-scale, cross-functional initiatives intended to improve performance, financial results, customer satisfaction, and compliance.
- Provide strategic and policy guidance for assigned initiatives.
- Organize work teams and drive consensus while maintaining end-to-end policy and process integrity.
- Identify and confirm project participants; establish project plans; sustain team engagement and productivity; facilitate meetings; document recommendations; and oversee implementation.
- Analyze data, workflows, policies, procedures, staff organization, and skills to execute initiatives.
- Use project management software and tools, including Excel, PowerPoint, Visio, and Microsoft Project.
- Lead staff at all levels who are responsible for initiatives in the company’s operating plan, supporting their success, development, completion, and communication.
- Assist other project leaders with facilitation, analysis, process mapping, brainstorming, and project management issues.
- Write and deliver communications to all organizational levels to support awareness and effectiveness of process improvement initiatives.
- Provide other support as needed to improve business performance.
- Perform other duties as assigned and comply with all policies and standards.
Benefits
- Competitive pay
- Health insurance
- 401(k)
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- Paid holidays
- Flexible approach to work, with remote, hybrid, field, or office schedules
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What This Job Offers
Job Type
Full-time
Career Level
Senior
