Program Manager II

Blue Cross Blue Shield of Massachusetts•Boston, MA

3d•$94,410 - $115,390•Onsite

About The Position

The Payment Integrity Senior Project Manager will report to the Senior Director, Payment Integrity and will lead the implementation of critical projects focused on improving how Blue Cross ensures that health care claims are paid correctly. Payment Integrity is a key area of focus at Blue Cross and is recognized as an opportunity for innovation with high potential value and cost savings. This is a hands-on role responsible for the end-to-end management of medium-to-high complex projects that are central to our company's strategic objectives. The Senior Project Manager will orchestrate the efforts of cross-functional teams to ensure these high-priority projects are delivered successfully, on schedule, and within budget. The ideal candidate has strong experience in project management methodologies and understands how to navigate complex stakeholder environments to drive results.

Requirements

Bachelor's degree in healthcare administration, business, finance, or a related field.
5+ years of direct, hands-on experience in project management, specifically leading complex, large-scale, and highly visible projects.
Proven track record of successfully implementing projects within the healthcare payment integrity or claims processing space.
Expertise in project management methodologies (e.g., Agile, Waterfall) and proficiency with project management software (e.g., Jira, Smartsheet, MS Project).
Exceptional organizational skills and a demonstrated ability to manage multiple priorities in a fast-paced environment.
Strong leadership and communication skills, with the ability to influence and motivate cross-functional teams and report effectively to senior management.
In-depth understanding of the project lifecycle and the intricacies of implementing business and technology solutions.
High school degree or equivalent required unless otherwise noted above

Nice To Haves

Experience with process improvement methodologies (e.g., Lean, Six Sigma).
Strong analytical and problem-solving skills with a data-driven approach to decision-making.
Deep knowledge of medical coding, billing, and reimbursement methodologies.

Responsibilities

End-to-End Project Management: Take full ownership of highly visible payment integrity projects, from initial planning and scoping through to implementation, launch, and post-launch analysis.
Detailed Project Planning: Develop and manage comprehensive project plans, defining project scope, timelines, resource requirements, and budgets for critical initiatives.
Cross-Functional Team Leadership: Lead and coordinate the day-to-day activities of project teams, ensuring clear communication and accountability across departments like IT, Claims, Analytics, and Provider Relations.
Stakeholder Communication: Serve as the primary point of contact for high-visibility projects, providing clear, concise, and regular status updates and reports to senior leadership and key stakeholders.
Risk and Dependency Management: Proactively identify, track, and mitigate project risks, issues, and dependencies to ensure smooth and successful implementation.
Implementation and Execution: Drive the execution of project tasks, manage deliverables, and ensure project milestones are met, holding team members and stakeholders accountable.
Performance Tracking: Define and track key project metrics and KPIs to measure success and report on the business impact of completed projects to leadership