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.

The Senior Project Manager for Claims Operations drives complex, multi-workstream initiatives that span people, process, data, and technology. Key areas include :

• 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.
• Technology Enablement : Oversee requirements, configuration, and testing for platforms.
• Delivery Excellence : Plan and execute across Waterfall / Agile or hybrid approaches.
• Risk, Compliance & Quality : Ensure alignment to CMS, HIPAA, state regulations, and audit readiness.
• Vendor & Stakeholder Management : Manage SOWs and partner performance.
• People Leadership & Culture : Model a high-performance, collaborative culture.

Knowledge / Skills / Abilities :

Tools / Methods (examples) : Salesforce, QNXT (or similar core claims), 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

Preferred Experience : 7-9 years of project / program management with direct impact on Claims Operations

Preferred License, Certification, Association : PMP (Project Management Professional) strongly preferred. Lean Six Sigma Black Belt preferred (Green Belt considered). Agile / Scrum certification (e.g., CSM, PMI-ACP, SAFe) desirable. Salesforce Administrator or relevant platform certification a plus.

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