Senior Project Manager, Claims Operations

Senior Project Manager For Claims Operations

Manages people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project / program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members.

Expanded Scope :

• Strategy & Road Mapping :
• Translate business strategy into a prioritized project roadmap; define scope, OKRs / KPIs, value hypothesis, and measurable success criteria.
• Process Optimization :
• Lead current / future-state mapping, root cause analysis, and continuous improvement (Lean / Six Sigma). Design scalable workflows and controls across intake, adjudication, adjustments, appeals / grievances, and payment integrity.
• Technology Enablement :
• Oversee requirements, configuration, and testing for platforms such as Salesforce, QNXT, RPA / automation, and analytics / reporting.
• Delivery Excellence :
• Plan and execute across Waterfall / Agile or hybrid approaches; lead UAT, cutover, and postgo-live; steward change management.
• Risk, Compliance & Quality :
• Ensure alignment to CMS, HIPAA, state regulations, and audit readiness. Establish governance, RAID, and quality gates.
• Vendor & Stakeholder Management :
• Manage SOWs and partner performance; facilitate executive steering, operational readiness, town halls, and cross-functional standups.
• People Leadership & Culture :
• Model a high-performance, collaborative culture; mentor PMs / analysts; promote data-driven decision making and continuous improvement.

Knowledge / Skills / Abilities :

Tools / Methods (examples) : Salesforce, QNXT, JIRA / Azure DevOps, MS Project / Smartsheet, Visio / Miro / Lucid, SQL, Excel, PowerPoint, Power BI / Tableau, Confluence, ServiceNow; Lean / Six Sigma; Agile / Waterfall / Hybrid.

Job Qualifications : Required Education :

Bachelor's Degree or equivalent combination of education and experience.

Required Experience :

5-7 years of project / program management with direct impact on Claims Operations.

Preferred Education :

Graduate Degree or equivalent combination of education and experience; formal training / coursework in project management, process improvement, change management, or healthcare operations; specialized training in Salesforce administration, process mapping, UAT / QA, or data analytics.

Preferred Experience :

7-9 years of project / program management with direct impact on Claims Operations; proven leadership of multi-vendor, multi-system implementations; track record in process mapping, workflow redesign, automation, and control design; experience creating and delivering training, SOPs, job aids, and communications; leading readiness, cutover planning, and postgo live stabilization; hands-on governance, quality assurance, risk management, and escalation handling in a regulated environment; proficiency with Salesforce, QNXT, SQL, Excel, JIRA / Azure DevOps, and PM / visualization tools; experience facilitating high-visibility forums; prior people leadership or mentoring of PMs / analysts is a plus.

Preferred License, Certification, Association :

PMP (Project Management Professional) strongly preferred; Lean Six Sigma Black Belt preferred (Green Belt considered); Agile / Scrum certification desirable; Salesforce Administrator or relevant platform certification a plus.

To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. Pay Range : $77,969 - $155,508 / ANNUAL