Program Manager, Payment Integrity

Ready to help us transform healthcare? Bring your true colors to blue. 

What we need

The BCBSMA Payment Integrity (PI) team is dedicated to safeguarding healthcare claims by identifying and addressing provider billing and coding errors. We are seeking a Senior Program Manager to lead the execution of key medical cost-savings initiatives and support the implementation of our evolving governance model.

This role will oversee a project manager and supporting data team to drive the successful execution of critical cost-savings and strategic programs. The Program Manager will manage the oversight and execution of initiatives originating from the Payment Integrity Steering Committee.

In addition, this role will act as a key liaison with the Blue Cross Blue Shield Association, ensuring alignment with national Payment Integrity strategies, sharing best practices, and coordinating cross-Plan initiatives.

Key Responsibilities

1. Lead and Develop a High-Performing Team
Provide strategic leadership, coaching, and mentorship to project managers and analytic resources. Foster accountability, professional growth, and collaboration to ensure successful execution of internal and external payment integrity initiatives.

2. Oversee Payment Integrity Programs
Manage a portfolio of high-impact medical cost savings initiatives. Ensure the development of comprehensive project plans, proactive risk mitigation, milestone tracking, and clear status reporting to the Payment Integrity Steering Committee. Drive timely and measurable program outcomes.

3. Support Governance and Strategic Communication
Manage governance processes for the cross-functional Payment Integrity Steering Committee, including agenda setting, meeting facilitation support, documentation of minutes, and tracking of action items. Oversee creation and distribution of the monthly Payment Integrity newsletter to ensure transparency and stakeholder engagement. Maintain and update the Payment Integrity strategic plan.

 

We’re Looking for:

< >Bachelor’s Degree required. Excellent verbal and written communication skills, with experience facilitating meetings and presenting to diverse audiences. Strong analytical skills and proficiency in working with and analyzing data to track performance and inform decisions. Very strong technical aptitude with the ability to use Microsoft products effectively, including project management software.

What You Bring:

< >Experience in leading or mentoring team members required; direct people management experience preferred. Proven ability to manage a portfolio of complex projects, set priorities for a team, and drive initiatives to completion.5+ years of experience in project or program management, preferably within a healthcare payment integrity, finance, or procurement environment. 

What You’ll Gain:

In this role, you will gain significant visibility into the strategic operations of our Payment Integrity department while developing your leadership skills. You will have the opportunity to lead a team dedicated to high-impact projects that contribute directly to our corporate savings goals. You will play a crucial part in managing the resources and partnerships needed to transform our payment integrity capabilities and ensure we remain at the forefront of the industry.

Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

Location

Boston, Hingham

Time Type

Full time

Salary Range: $125,460.00 - $153,340.00

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting.  We may ultimately pay more or less than the posted range, and the range may be modified in the future.  An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note:  No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that the confidence gap and imposter syndrome can  prevent  amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.