Project Manager – Payment Integrity, Quality Operations

Job not on LinkedIn

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $75.1k - $123.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👷‍♀️ Project Manager

👻 Ghost score 2%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

📦 Logistics

💰 $2M Venture Round on 2015-01

Healthcare • Insurance • Logistics

EXL is a business consulting and services firm that focuses on leveraging data to enhance business operations and decision-making. With a strong emphasis on collaboration and adaptability, EXL partners with organizations to address their unique needs and culture while integrating data science and technology solutions. The company's areas of expertise include operations management, decision analytics, digital transformation, and various industries such as healthcare, finance, and insurance. EXL's mission is to help clients drive business evolution and maintain competitive advantage through tailored solutions and effective use of data.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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