Technical Project Manager

Job Summary: Lead technical delivery of projects that design, build, integrate, and maintain systems for medical claims processing. Act as the bridge between business stakeholders (claims operations, clinical reviewers, finance, compliance) and engineering/IT teams to deliver scalable, compliant, and timely solutions that improve claims accuracy, throughput, and reporting.

Key Responsibilities:

Lead end-to-end project lifecycle: scope, planning, budgeting, resource allocation, risk management, delivery, and post-implementation review.

Translate business requirements (claims adjudication rules, payment integrity, denials management, appeals workflows, provider and member data needs) into technical specifications and user stories.

Coordinate cross-functional teams: software engineers, QA, data engineers, BI, integration specialists, vendors, product owners, and clinical SMEs.

Oversee integrations with core claims systems, EDI (837/277/835), clearinghouses, provider portals, HIEs, and authorization/eligibility services.

Manage data migration, ETL pipelines, data quality, and claim-level reconciliation tasks.

Ensure regulatory and compliance requirements are met (HIPAA, HIPAA security, CMS, state regulations); support audits and documentation.

Track project metrics, status, dependencies, and deliver regular executive-level updates and dashboards.

Facilitate UAT, build deployment plans, coordinate cutovers, and manage incident response and rollbacks.

Implement and enforce best practices for Agile delivery (Scrum/Kanban), CI/CD, release management, and change control.

Identify process improvements and technical debt reduction opportunities to increase claims processing efficiency and reduce denials.

Required Qualifications:

4+ years managing technical projects in healthcare, insurance, or related industries; at least 2–3 years focused on medical claims systems preferred.

Bachelor's degree in Computer Science, Information Systems, Health Informatics, Business, or related field.

Demonstrated experience with claims processing systems (e.g., Epic Claims, QNXT, TriZetto, ClaimSphere, Facets) or broad EHR/PM/Revenue Cycle integrations.

Strong working knowledge of healthcare transactions and standards: EDI 837/278/276/277/835, X12, HL7/FHIR, NCPDP.

Proven ability to write/translate functional requirements, acceptance criteria, and use cases for technical teams.

Solid understanding of data architectures, ETL processes, SQL, and reporting/BI (e.g., Power BI, Tableau).

Experience with Agile delivery and tools such as Jira, Confluence, Azure DevOps.

Excellent stakeholder communication, negotiation, and leadership skills.

Knowledge of HIPAA, HITRUST, SOC2, and healthcare compliance considerations.

Preferred:

PMP, PMI-ACP, or Scrum Master certification.

Experience with cloud platforms (AWS, Azure), microservices, APIs, and CI/CD pipelines.

Background in payment integrity, revenue cycle, denials management, medical coding (ICD/CPT), or clinical review workflows.

Experience managing third-party vendor implementations and SaaS integrations.

Key Competencies and Skills:

Project planning and prioritization

Risk identification and mitigation

Technical acumen and systems thinking

Data-driven decision making and KPI tracking

Strong documentation and process governance

Conflict resolution and cross-team collaboration

Typical KPIs:

On-time delivery rate

Project budget variance

Defect/issue escape rate (post-release)

Claims processing cycle time improvements

Denial rate reduction and recovery value

UAT pass rate and customer satisfaction

Work Conditions:

• Full-time; may require occasional extended hours during major releases or cutovers.