Program Manager - Process Design & Improvement: Claims

Job Description

Our client is launching a high-visibility Medicaid Transformation initiative aimed at standardizing operations, reducing manual work, and improving claims processing outcomes. The environment has historically operated with inconsistent procedures, decentralized processes, and platform configuration challenges that are creating downstream impacts to claims adjudication and payment accuracy. They are seeking transformational Program Managers who can drive business process improvement efforts while partnering closely with technology teams. This is not a purely technical program management role. The focus is on understanding how system configuration, business processes, and operational execution intersect to create inefficiencies, then designing and implementing sustainable solutions. These resources will be highly visible across the organization, regularly engaging with Directors, VPs, and SVPs to identify root causes, redesign workflows, establish controls, and define meaningful success metrics.

Skills and Requirements

• Program Manager-level leadership experience driving large-scale transformation initiatives

• Strong process improvement background utilizing Lean, Six Sigma, Continuous Improvement, or Operational Excellence methodologies

• Proven experience conducting root cause analysis and implementing corrective actions

• Experience designing future-state business processes and operational workflows

• Ability to create controls, governance models, KPI frameworks, and process metrics

• Technical foundation from a previous role such as: o Engineer o Business Analyst o QA Analyst o Solution Architect

• Experience leading Agile initiatives as a: o Scrum Master o Program Manager o Release Train Engineer (RTE)

• Ability to lead delivery while driving process transformation efforts

• Strong stakeholder management skills with experience working directly with senior leadership

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [email protected].