Payment Integrity Project Manager

Blue Cross and Blue Shield of Massachusetts, Inc.; Hingham (MA); On-site; USD 94,000 - 115,000; Full time

Job summary

Blue Cross Blue Shield of Massachusetts, Inc. is seeking a Payment Integrity Project Manager to lead end-to-end delivery of high-visibility initiatives that ensure accurate healthcare claim payments.

This hands-on role manages scope, timelines, budgets, and stakeholder communications across IT, Claims, Analytics and Provider Relations. Ideal candidates bring 5+ years of project management experience in healthcare payor environments and fluency with Agile or Waterfall methods, plus tools like

Qualifications

• 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 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.

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

Skills

Project management

Stakeholder management

Cross-functional leadership

Agile/Waterfall

Communication

Healthcare domain knowledge

Education

Bachelor's degree in healthcare administration, business, finance, or related field

Tools

Jira

Smartsheet

MS Project

Job description

Ready to help us transform healthcare? Bring your true colors to blue.

The Role:

The Payment Integrity Project Manager will report to the Program Manager, 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.

Key Functions

• 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

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties.

We’re Looking For:

• 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.

Preferred Qualifications

• 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.

Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

Location Boston, Hingham Time Type Full timeSalary Range: $94,410.00 - $115,390.00

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that confidence gap and imposter syndrome can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.