5+ years of experience in program or project management within health insurance, specifically claims., Strong knowledge of health insurance products, claims processing, provider contracting, and regulatory requirements., Proficiency in Agile, Scrum, and Waterfall methodologies., Excellent leadership, communication, and stakeholder management skills..
Key responsabilities:
Develop and execute program strategies aligned with the company's goals in health insurance plan development and administration.
Manage multiple projects related to product development, provider networks, regulatory compliance, and customer experience improvements.
Work closely with actuarial, underwriting, claims, network management, IT, and regulatory teams to ensure seamless execution.
Identify and implement best practices for operational efficiency and member experience enhancements.
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Genesis10 is a professional technology services firm providing Staffing, Direct Hire, Digital Consulting, Talent Creation and Onshore Managed Services. Genesis10 is dedicated to developing, nurturing, and deploying talent to help organizations implement business and technology initiatives cost-effectively. We help our clients accelerate growth programs and drive innovation for their customers. Genesis10 serves more than 150 clients including blue chip Fortune 100 enterprises and privately-held high growth companies in sectors such as financial services, healthcare, communications, energy, transportation, consumer goods, and technology. Headquartered in New York, Genesis10 has sales and recruiting offices throughout North America, and seven domestic delivery centers.
Genesis10 is currently looking for a Sr Project Manager with Health Insurance plans on the Commerical side for a migration project for a client in Minneapolis MN. Able to work 100% remote.
Job Summary:
We are seeking a Senior Project Manager with experience in health insurance plans on the commercial side to oversee and drive strategic initiatives across multiple projects. This role will be responsible for aligning programs with business objectives, managing cross-functional teams, and ensuring the successful execution of initiatives related to The ideal candidate has a strong background in claims and the lifecycle of claims processing combined with excellent leadership and project management skills. If resource does not have commercial side they will consider Medicare, but not Medicaid experience.
For this PM, they will be managing the commercial side migration which is approximately 4 of the 9 platforms. This resource needs to be someone who thinks from a business perspective and how to make them more efficient. Their plans are not standard in this area so someone that will rationalize and make recommendations and drive automation determinations with high accuracy. The commercial side has the largest impact in terms of number of members impacted. This is about 65% of Medica members. There is a lot of visibility in this area. There are a lot of work streams, the teams are matrixed, and resource will cover light financial management and being able to provide data up to the program manager. Some of the workstreams include member, customer, networks, eligibility, and adjudication. Resource will also need to be able to work across a variety of business areas such as sales, payments, eligibility etc.
Key Responsibilities:
Program Strategy & Execution: Develop and execute program strategies aligned with the company's goals in health insurance plan development and administration.
Project Oversight: Manage multiple projects related to product development, provider networks, regulatory compliance, and customer experience improvements.
Stakeholder Collaboration: Work closely with actuarial, underwriting, claims, network management, IT, and regulatory teams to ensure seamless execution.
Regulatory Compliance: Ensure programs align with state and federal healthcare regulations (e.g., ACA, CMS, Medicare, Medicaid).
Process Improvement: Identify and implement best practices for operational efficiency and member experience enhancements.
Budget & Resource Management: Manage program budgets and optimize resource allocation.
Reporting & Metrics: Provide regular status updates to senior leadership on program performance, risks, and key deliverables.
Vendor & Provider Relations: Manage relationships with external vendors, healthcare providers, and third-party administrators.
Qualifications:
Experience: 5+ years of experience in program or project management within the health insurance specific to claims.
Skills:
Strong knowledge of health insurance products, claims processing, provider contracting, and regulatory requirements.
Experience managing projects within Commercial or Medicare
Proficiency in Agile, Scrum, and Waterfall methodologies.
Familiarity with healthcare IT systems
This role will be 60% on the business side and 40% technology
Excellent leadership, communication, and stakeholder management skills.
Preferred Qualifications:
Experience working with health insurance payers, providers, or regulatory agencies.
Experience working on a claims migration program
Compensation: Hourly W2 pay rate $90- $110
Only candidates available and ready to work directly as Genesis10 employees will be considered for this position.
If you have the described qualifications and are interested in this exciting opportunity, apply today!
Ranked a Top Staffing Firm in the U.S. by Staffing Industry Analysts for six consecutive years, Genesis10 puts thousands of consultants and employees to work across the United States every year in contract, contract-for-hire, and permanent placement roles. With more than 300 active clients, Genesis10 provides access to many of the Fortune 100 firms and a variety of mid-market organizations across the full spectrum of industry verticals.
For contract roles, Genesis10 offers the benefits listed below. If this is a perm-placement opportunity, our recruiter can talk you through the unique benefits offered for that particular client. Benefits of Working with Genesis10:
• Access to hundreds of clients, most who have been working with Genesis10 for 5-20+ years. • The opportunity to have a career-home in Genesis10; many of our consultants have been working exclusively with Genesis10 for years. • Access to an experienced, caring recruiting team (more than 7 years of experience, on average.) • Behavioral Health Platform • Medical, Dental, Vision • Health Savings Account • Voluntary Hospital Indemnity (Critical Illness & Accident) • Voluntary Term Life Insurance • 401K • Sick Pay (for applicable states/municipalities) • Commuter Benefits (Dallas, NYC, SF)
For multiple years running, Genesis10 has been recognized as a Top Staffing Firm in the U.S., as a Best Company for Work-Life Balance, as a Best Company for Career Growth, for Diversity, and for Leadership, amongst others. To learn more and to view all our available career opportunities, please visit us at our website. Genesis10 is an Equal Opportunity Employer. Candidates will receive consideration without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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