Project Manager – Payment Integrity, Quality Operations

Vaga não está no LinkedIn

🕒 Agosto 26

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $75.100 - $123.400 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👷‍♀️ Gerente de Projetos

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EXL

SiteLinkedInTodas as Vagas

10.000+ funcionários

🏥 Saúde

🛡️ Seguros

📦 Logística

💰 $2.000.000 Venture Round em 2015-01

Healthcare • Insurance • Logistics

Escolher um parceiro digital vai além das capacidades — trata-se de colaboração e caráter.

Descrição

• Partner with quality leaders, quality audit teams, reporting, MIS, configuration, technology teams, offshore quality partners, and end users to define quality system needs, workflow requirements, priorities, and enhancement opportunities • Own assigned roadmap work from intake through completion, including workflow changes, process improvements, reporting needs, business workflow testing, new client workflow setup, implementation timelines, stakeholder follow-up, barrier resolution, and project closure • Build and maintain test plans, test scenarios, test scripts, issue logs, implementation trackers, and testing documentation • Execute user acceptance testing, regression testing, end-to-end validation, business workflow testing, and data validation before deployment • Document testing results, defects, risks, decisions, approvals, open items, testing evidence, and implementation outcomes • Drive defect follow-up by troubleshooting issues, validating fixes, confirming quality requirements, and communicating status updates • Own intake, review, prioritization support, and tracking of enhancement requests • Validate configuration updates, user interface changes, and workflow enablement activities • Develop rollout plans including timelines, stakeholder communications, training needs, go-live readiness, and post-launch support • Create and maintain user guides, job aids, release notes, FAQs, training materials, process flows, and support resources • Lead training sessions, demonstrations, knowledge-transfer activities, and stakeholder walkthroughs • Monitor system performance, workflow outcomes, user feedback, reporting outputs, and post-launch issues • Evaluate workflows, system functionality, business rules, reporting outputs, quality processes, and user experience to recommend improvements • Maintain alignment with operational standards, compliance expectations, audit requirements, HIPAA, business process controls, and governance processes • Serve as the main point of contact for quality system questions, issue escalation, defect follow-up, stakeholder coordination, and support

🎯 Requisitos

• Bachelor’s degree in healthcare administration, business, quality management, project management, analytics, information systems, or a related field preferred • Lean Six Sigma, PMP, CAPM, or related process improvement/project management certification preferred • 5–7 years of experience, or equivalent experience, in project coordination, healthcare operations, claims auditing, quality operations, Payment Integrity, system testing, reporting, data analysis, or process improvement • Experience supporting system enhancements, workflow changes, user interface updates, business workflow testing, user acceptance testing, regression testing, test scenario development, and end-to-end validation • Knowledge of healthcare claims auditing, Payment Integrity workflows, quality audit operations, healthcare audit terminology, compliance requirements, HIPAA, audit expectations, and business process controls • Hands-on experience documenting requirements, test plans, test scripts, testing results, defects, risks, approvals, rollout plans, implementation outcomes, and issue resolution • Project management or strong project coordination experience required, including timelines, milestones, risks, roadblocks, stakeholder updates, enhancement tracking, implementation support, post-launch follow-up, and closure • Strong Excel and presentation skills required • Strong understanding of healthcare audit operations, quality workflows, quality business processes, reporting needs, and operational support needs within Payment Integrity • Strong analytical, problem-solving, organization, prioritization, documentation, follow-up, and stakeholder management skills • Ability to understand workflow logic, business rules, audit process steps, reporting outputs, testing results, and operational impacts • Ability to translate quality priorities into clear project plans, workflow solutions, quality controls, and sustainable operating practices • Ability to communicate clearly through written updates, verbal discussions, presentations, testing summaries, risk updates, action items, and recommendations • Ability to collaborate with onshore quality teams, offshore quality partners, configuration, MIS, reporting, training, technology partners, and end users • Ability to independently own assigned work, execute testing and validation activities, drive workflow improvements, strengthen quality controls, and deliver work on time

🏖️ Benefícios

• Up to 10% annual travel for team meetings and limited client onsite engagements • Benefits information available at https://www.exlservice.com/us-careers-and-benefits • 100% remote work from a home office