Project Manager - Healthcare Claims

We are seeking an experienced Senior Project Manager – Healthcare Claims to lead a large-scale application development and modernization program in Troy, Michigan. The ideal candidate will bring extensive IT project management experience, strong healthcare payer and claims domain knowledge, and a proven track record of delivering complex engagements within defined scope, budget, and schedule commitments. This role requires demonstrated expertise in fixed-price, fixed-scope, and fixed-budget project delivery , along with strong financial management, governance, risk mitigation, and stakeholder management capabilities. The successful candidate will serve as the primary onshore point of contact, coordinating cross-functional onshore and offshore teams to ensure predictable delivery and alignment with contractual commitments. A valid PMP certification is mandatory. Key Responsibilities 1. Project Delivery & Governance Lead end-to-end project delivery, ensuring adherence to approved scope, schedule, budget, and quality objectives. Develop and maintain integrated project plans covering requirements, design, development, integration, testing, UAT, deployment, hypercare, and transition to support. Establish and maintain project governance processes, including milestone tracking, status reporting, RAID management, dependency tracking, and executive escalations. Conduct regular project reviews and governance meetings with customer and internal stakeholders. Monitor contractual deliverables and proactively address deviations from established project baselines. Coordinate onshore and offshore teams to ensure effective collaboration, accountability, and timely execution. Manage projects within approved fixed-price, fixed-scope, budget, and schedule commitments. Maintain strict scope control and prevent unauthorized changes to agreed requirements and deliverables. Establish and enforce formal change-control processes for requirements outside the approved baseline. Evaluate change requests for their impact on cost, effort, resources, architecture, testing, dependencies, and delivery timelines. Monitor project financials, resource utilization, budget consumption, estimates-to-complete, and forecast-to-complete. Identify cost and schedule variances early and implement corrective actions and recovery plans. Track project assumptions, dependencies, exclusions, acceptance criteria, and customer responsibilities throughout the engagement. Apply working knowledge of healthcare payer operations and the end-to-end claims processing lifecycle. Collaborate with business, product, technology, and operations stakeholders across areas including: Claims intake, processing, and adjudication Member eligibility and benefits Provider-related claims processing Claims pricing, payment, adjustments, and status EDI transactions and system integrations HIPAA-regulated healthcare environments Partner with Business Analysts, Product Owners, Architects, Development Leads, and QA teams to translate business requirements into actionable delivery plans. Ensure alignment between business objectives, technical implementation, testing, and delivery milestones. Serve as the primary onshore point of contact for project delivery and customer coordination. Build and maintain strong relationships with customer business leaders, technology leadership, and internal delivery teams. Prepare and present clear executive-level updates covering project progress, milestones, financial performance, risks, issues, dependencies, and decisions required. Manage stakeholder expectations and maintain alignment between contractual commitments and delivery objectives. Escalate critical issues promptly, supported by impact assessments, mitigation strategies, and recommended actions. Facilitate timely decision-making and resolve conflicts that could affect project outcomes. Maintain a comprehensive RAID register covering risks, assumptions, issues, and dependencies. Assign clear ownership and mitigation plans for identified risks and issues. Proactively identify dependencies across customer teams, vendors, infrastructure, environments, interfaces, security, data, testing, and releases. Monitor critical-path activities and drive timely resolution of blockers. Lead recovery planning and corrective actions when schedule, budget, scope, or quality objectives are at risk. 6. Quality Assurance & Release Management Partner with engineering, architecture, and QA leadership to incorporate quality objectives into project planning and execution. Track testing progress, defect resolution, acceptance criteria, and release-readiness metrics. Coordinate user acceptance testing (UAT), production-readiness reviews, deployment planning, cutover activities, and hypercare. Ensure appropriate stakeholder approvals and customer acceptance are obtained at contractual milestones. Oversee transition-to-support activities to facilitate a smooth handover following production deployment. Required Qualifications 10–12+ years of overall IT experience, including significant experience in project or program management. PMP certification is mandatory. Demonstrated success managing fixed-price, fixed-scope, fixed-budget engagements with committed delivery schedules. Strong healthcare domain knowledge, preferably within health insurance, payer operations, and claims processing. Experience managing distributed onshore and offshore delivery teams. Strong understanding of SDLC, Agile or iterative delivery methodologies, testing, release management, and production deployment. Proven expertise in project financial management, including budget tracking, forecasting, resource planning, and variance analysis. Strong scope management and formal change-control experience. Excellent risk, issue, dependency, and escalation management skills. Exceptional written and verbal communication skills, including the ability to communicate effectively with executive stakeholders and technical teams. Strong leadership, negotiation, conflict-resolution, and decision-making capabilities. Ability to operate effectively in a high-visibility, customer-facing, schedule-driven environment. Ability to work onsite in Troy, Michigan, two days per week . #J-18808-Ljbffr SRM Digital