Initiative Project Leader - Integrity Unified Ecosystem

Location: This role requires associates to be in-office 3 days per week
, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Alternate locations may be considered if candidates reside within a commuting distance from an office,
with ideal candidates being able and willing to work Eastern or Central Time Zone business hours.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Initiative Project Leader
- Payment Integrity Unified Ecosystem is responsible for analyzing, determining and driving opportunities to standardize, eliminate waste and improve end-to-end processes to transform Payment Integrity solutions that will enable value and improve member, end-user, and provider experience.

This Leader will lead the PI Unified Ecosystem initiative by coordinating business and technology partners and driving the development of new Payment Integrity solutions and applications.

Primary duties may include, but are not limited to:

• Serves as a thought leader regarding improvements to end-to-end processes with our providers, members, and internal end-users in mind.

• Connects critical dots across matrixed organizations supporting the PI Unified Ecosystem through integration points in Claims, Health Plans, Operations, PE&C, PSCCR, Finance, Actuary, Digital, and IT.

• Leads the PI Unified Ecosystem from assessment through implementation, developing actionable project plans and ensuring business controls are in place to monitor sustainable results.

• Builds consensus across business and technology work streams, leads root cause analysis, uncovers trends, contributes to solution definition, and determines internal and external best practices.

• Establishes and manages program milestones, dependencies, risks, decisions, and recovery plans to keep the development of new Payment Integrity solutions and applications moving forward.

• Uses data-supported reporting to communicate program health, identify delivery gaps, and provide objective red, yellow, and green status updates.

• Articulates initiative drivers, investment value, anticipated return, progress, risks, and results through compelling communications tailored to executive, business, and technical audiences.

• Creates and maintains an end-to-end PI Unified Ecosystem roadmap that enables informed prioritization, cross-functional alignment, and delivery against major transformation milestones.

Requires a BA/BS degree in a related field and a minimum of 8 years of professional experience in an operations environment including 7 years of leading and directing large enterprise-wide projects; or any combination of education and experience, which would provide an equivalent background.

• Payment Integrity, healthcare payer, claims, cost-of-care, healthcare technology, or related healthcare operations experience preferred.

• Proven experience leading large-scale, multiyear enterprise transformation initiatives involving business, product, operations, digital, and technology partners preferred.

• Strong project leadership experience, including developing project plans, establishing milestones, managing dependencies and risks, and driving cross-functional work through implementation preferred.

• Demonstrated ability to navigate ambiguity, independently determine next steps, solve complex problems, and move initiatives forward with limited direction preferred.

• Strong business, systems, data, and digital fluency, including the ability to analyze information, identify trends, evaluate opportunities, and translate findings into actionable recommendations preferred.

• Exceptional executive communication and storytelling skills, including experience developing compelling business cases, presentations, and value or return-on-investment narratives preferred.

• Proven ability to build trusted relationships, influence without direct authority, and drive alignment and accountability across highly matrixed organizations preferred.

• Experience developing strategic roadmaps and working within Agile, product-development, or…