Healthcare Claims Project Manager

3 weeks ago


Baltimore, Maryland, United States J29, Inc Full time
Job Title: Healthcare Claims Project Manager

Job Summary:

We are seeking a highly skilled and experienced Healthcare Claims Project Manager to join our consulting team at J29, Inc. This pivotal and dynamic role reports directly to the Program Director and offers significant growth potential.

Key Responsibilities:

Oversee and manage healthcare projects related to claims processing and payment.

Analyze and interpret Statements of Work (SOWs) and Requests for Proposals (RFPs) to identify opportunities, research solutions, and develop cohesive strategies for implementation.

Lead projects or manage subcontracted portions by thoroughly investigating opportunities and formulating strategies to ensure successful execution and compliance with client requirements.

Manipulate and analyze medical claims data in Excel, utilizing pivot tables and other advanced Excel techniques to identify trends and insights.

Manage and execute project budgets, ensuring resources are utilized effectively within the established budget.

Develop and implement strategies to improve claims processing efficiency and accuracy.

Collaborate with clients to understand their needs and provide tailored solutions.

Analyze and interpret claims data to identify trends, issues, gaps, or key areas of focus for the project at hand.

Ensure compliance with all relevant regulations and standards.

Coordinate with IT teams to manage file transfers and ensure data integrity.

Provide training and support to clients and team members on claims processing and payment systems.

Prepare detailed reports and presentations for clients and stakeholders.

Monitor project progress and adjust plans as necessary to meet deadlines and objectives.

Qualifications:

Minimum of 5+ years of experience in healthcare claims processing and payment.

3+ years of exposure to leading and managing programs that range from 3+ full-time resources and at/above $4M in total budget.

Experience working with multiple claim payment systems that support activities in the end-to-end claims processing flow.

Strong understanding of various claims processing files and file transfer processes.

Excellent project management skills with a proven track record of managing complex healthcare projects.

Strong analytical and independent problem-solving abilities in a fully remote environment.

Excellent communication and interpersonal skills working in a cross-collaborative environment.

Proficiency in relevant software and tools (e.g., Excel, MS Planner, MS Project, EncoderPro, Codify, SharePoint, Salesforce).

Ability to work independently and as part of a team.

Preferred Skills:

Experience in a healthcare consulting environment serving government programs.

Knowledge of healthcare regulations and standards.

Familiarity with claims related to Medicaid, TRICARE, and group health plans is a plus.

Management and leadership skills ranging from a team of direct or indirect reports that are supporting claims or record review.

Exposure to State or Federal contracts with direct engagement with government stakeholders.

Certification in project management (e.g., PMP, PRINCE2).


  • Claims Specialist

    3 weeks ago


    Baltimore, Maryland, United States Cornerstone Transportation Consulting Full time

    Job OpportunityCornerstone Concilium, Inc. is seeking a skilled Claims Analyst to join our team. As a Claims Analyst, you will play a critical role in coordinating and reviewing claims, changes, and early warnings. You will work closely with various Program/Project teams to assess, mitigate, and resolve claims.Key Responsibilities:Maintain a comprehensive...


  • Baltimore, Maryland, United States Baltimore City Public Schools Full time

    Job SummaryOversee the management of contracts for new construction and/or major renovations for multi-million-dollar capital programs.Key Responsibilities:Develop project plans, work breakdown, and schedules to ensure successful project completion on time and within budget.Provide oversight and direction to general contractors, construction managers, or...

  • Claims Examiner

    2 weeks ago


    Baltimore, Maryland, United States Sedgwick Full time

    About the Role:Sedgwick is seeking a skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for analyzing and processing workers' compensation claims to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.Key...

  • Claims Examiner

    4 weeks ago


    Baltimore, Maryland, United States Sedgwick Full time

    About SedgwickSedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Our mission is to help organizations protect their employees, customers, and assets while minimizing business interruptions.Job SummaryWe are seeking a skilled Claims Examiner to join our team. As a Claims Examiner, you will be...


  • Baltimore, Maryland, United States Jobot Full time

    Job SummaryWe are seeking a highly skilled Senior Claims Adjuster to join our dynamic claims team. The ideal candidate will have extensive experience in handling complex claims, particularly in trade credit insurance, and will work closely with our underwriting and risk teams to assess, manage, and resolve claims efficiently.Key ResponsibilitiesReview and...

  • Claims Examiner

    2 weeks ago


    Baltimore, Maryland, United States Sedgwick Full time

    About the Role:We are seeking a skilled Claims Examiner to join our team at Sedgwick. As a Claims Examiner, you will be responsible for analyzing and processing Workers Compensation claims on behalf of our valued clients.Key Responsibilities:Analyze and process claims through well-developed action plans to an appropriate and timely resolution.Negotiate...


  • Baltimore, Maryland, United States Baltimore City Public Schools Full time

    Job OverviewWe are seeking a highly skilled and experienced Construction Project Manager to oversee the management of contracts for new construction and/or major renovations for multi-million-dollar capital programs.The ideal candidate will have a strong background in construction management, with experience in developing project plans, work breakdown, and...


  • Baltimore, Maryland, United States Allied Universal Full time

    Advance your career in insurance claims with Allied Universal Compliance and Investigation Services. As a global leader in the industry, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our diverse and inclusive team is committed to innovation and excellence, making a significant impact in the...


  • Baltimore, Maryland, United States Allied Universal® Compliance and Investigations Full time

    Job DescriptionAdvance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services.As a global leader in insurance claim investigation, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our diverse and inclusive team is committed to innovation and excellence, making a...


  • Baltimore, Maryland, United States Michael Page Full time

    Project Manager Opportunity in Healthcare InteriorsMichael Page is seeking a skilled Project Manager to lead healthcare interior projects in Baltimore, MD. As a trusted General Contractor, our client specializes in design-build services and has earned a reputation for handling diverse projects, including ground-up construction, adaptive reuse, full...


  • Baltimore, Maryland, United States American Family Mutual Insurance Company Full time

    Transforming Claims CapabilitiesAt American Family Mutual Insurance Company, we're revolutionizing our claims services to put customers at the forefront of our expertise, technology, and innovative approaches.We're leveraging our knowledge, cutting-edge tools, and new ways of working to reimagine one of America's largest industries, creating a positive...


  • Baltimore, Maryland, United States Three Point Solutions Full time

    Job Title: Utilization Management Coordinator(Hybrid)Client: Health Care IndustryJob Description:Purpose:Support clinical teams by assisting with administrative tasks related to pre-service, utilization review, care coordination, and quality of care.Key Responsibilities: Perform member or provider related administrative support (e.g., benefit verification,...


  • Baltimore, Maryland, United States RIVUS Consulting LLC Full time

    Job OverviewRIVUS Consulting LLC is seeking a highly skilled Construction Manager/Project Representative to oversee the construction of water quality/waterway improvement projects.Key ResponsibilitiesObserve construction and perform coordination, documentation, and oversee inspectors on water quality/waterway improvement projects.Lead construction project...


  • Baltimore, Maryland, United States Michael Page Full time

    We are seeking a skilled Superintendent to lead our Healthcare Interiors Construction projects in Maryland. As a key member of our team, you will be responsible for supervising healthcare interior projects, including outpatient centers, and ensuring timely project completion within budget. Key Responsibilities Supervise healthcare interior projects,...


  • Baltimore, Maryland, United States Baltimore City Public Schools Full time

    Job OverviewAs a Construction Project Manager for Baltimore City Public Schools, you will oversee the management of contracts for new construction and/or major renovations for multi-million dollar capital programs.Key Responsibilities:Develop project plans, work breakdown, and schedules to ensure successful project completion on time and within...


  • Baltimore, Maryland, United States Johns Hopkins HealthCare Full time

    Job SummaryWe are seeking a highly skilled and experienced Capital Project Manager III to join our team at Johns Hopkins HealthCare. As a key member of our capital construction team, you will be responsible for managing complex construction projects from initiation to closeout, ensuring timely and within-budget delivery of projects.Key ResponsibilitiesManage...

  • Project Director

    2 weeks ago


    Baltimore, Maryland, United States OmniOn Power Full time

    Job OverviewWe are seeking a highly skilled Project Manager to lead the execution of medium-size projects and ensure that all related activities are in accordance with OmniOn Power policy, contractual agreements, quality standards, health, safety & environment requirements, financial targets, as well as schedule commitments.This is a virtual role with the...


  • Baltimore, Maryland, United States Johns Hopkins HealthCare Full time

    Sr. Engineering Project ManagerJohns Hopkins Health System is a leading healthcare organization that employs over 20,000 people annually. As a Sr. Engineering Project Manager, you will be part of a diverse team dedicated to delivering exceptional patient care and advancing the field of healthcare.Key Responsibilities:Develop and implement project plans for...


  • Baltimore, Maryland, United States Johns Hopkins HealthCare Full time

    At Johns Hopkins HealthCare, we are committed to providing a healthy and safe environment for our patients, visitors, and staff members. As a Sr. Engineering Project Manager, you will play a critical role in ensuring the success of our engineering and maintenance projects. Your responsibilities will include project planning, reviewing engineering design and...


  • Baltimore, Maryland, United States Johns Hopkins HealthCare Full time

    Job Title: Senior Engineering Project ManagerJohns Hopkins Health System is a leading healthcare organization that employs over 20,000 people annually. We are committed to providing a healthy and safe environment for our patients, visitors, and staff members.Job Summary:The Senior Engineering Project Manager will report to the Director of Engineering and be...