Project Manager – Payment Integrity Quality Operations

The Project Manager – Payment Integrity Quality Operations is a hands-on individual contributor role responsible for driving quality workflow improvements, business testing, reporting support, new client workflow setup, and implementation activities. This role partners with quality leaders, audit teams, reporting, MIS, configuration, offshore quality partners, technology teams, and end users to move assigned roadmap items from intake through completion. The ideal candidate will bring strong follow-up, documentation, testing, validation, and problem-solving skills to support consistent, scalable, and efficient Payment Integrity quality operations.

• Salary Range: $75,100 – $123,400 (based on experience, skills, and qualifications)

• Location: 100% Remote (U.S.-based)

• Up to 10% annual travel (for team meetings and limited client onsite engagements.)

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

• Partner directly with quality leaders, quality audit teams, reporting, MIS, configuration, technology teams, offshore quality partners, and end users to define quality system needs, workflow requirements, priorities, and enhancement opportunities that support operations.
• Own assigned roadmap work from intake through completion as the primary hands-on resource, including workflow changes, process improvements, reporting needs, business workflow testing, new client workflow setup, implementation timelines, stakeholder follow-up, barrier resolution, and project closure.
• Build and maintain test plans, test scenarios, test scripts, issue logs, implementation trackers, and testing documentation for system changes, user interface updates, reporting updates, workflow improvements, and new feature releases.
• Execute user acceptance testing, regression testing, end-to-end validation, business workflow testing, and data validation to confirm functionality, workflow outputs, business rules, and reporting results are accurate before deployment.
• Document testing results, defects, risks, decisions, approvals, open items, testing evidence, and implementation outcomes in a clear, organized manner to ensure issues are tracked through resolution and closure.
• Drive defect follow-up with technical, configuration, MIS, reporting, and quality stakeholders by troubleshooting issues, validating fixes, confirming quality requirements are met, and communicating status updates to stakeholders.
• Own the intake, review, prioritization support, and tracking of enhancement requests based on operational impact, user needs, compliance expectations, business value, quality goals, and scalability.
• Directly validate configuration updates, user interface changes, and workflow enablement activities to improve usability, workflow efficiency, data accuracy, reporting consistency, and end-user adoption.
• Develop rollout plans for new features, workflow changes, system updates, and new client workflow setup, including timelines, stakeholder communications, training needs, go-live readiness, and post-launch support.
• Create and maintain user guides, job aids, release notes, FAQs, training materials, process flows, and support resources to help end users successfully adopt system and workflow changes.
• Lead training sessions, demonstrations, knowledge-transfer activities, and stakeholder walkthroughs for end users, quality teams, and offshore quality partners as needed.
• Monitor system performance, workflow outcomes, user feedback, reporting outputs, and post-launch issues to identify adoption challenges, defects, risks, open items, and additional enhancement opportunities.
• Evaluate workflows, system functionality, business rules, reporting outputs, quality processes, and user experience to recommend practical improvements that increase efficiency, quality, consistency, compliance, and scalability.
• Maintain alignment with operational standards, compliance expectations, audit requirements, HIPAA, business process controls, and governance processes throughout system changes, workflow updates, testing, documentation, and implementation activities.
• Serve as the main point of contact for assigned quality system-related questions, issue escalation, defect follow-up, stakeholder coordination, and support between end users, quality teams, offshore quality partners, and technical support teams.

• Bachelor’s degree in healthcare administration, business, quality management, project management, analytics, information systems, or a related field preferred. Lean Six Sigma, PMP, CAPM, or related process improvement/project management certification preferred.
• 5–7 years of experience, or equivalent experience, in project coordination, healthcare operations, claims auditing, quality operations, Payment Integrity, system testing, reporting, data analysis, or process improvement.
• Experience supporting system enhancements, workflow changes, user interface updates, business workflow testing, user acceptance testing, regression testing, test scenario development, and end-to-end validation.
• Knowledge of healthcare claims auditing, Payment Integrity workflows, quality audit operations, healthcare audit terminology, compliance requirements, HIPAA, audit expectations, and business process controls.
• Hands-on experience documenting requirements, test plans, test scripts, testing results, defects, risks, approvals, rollout plans, implementation outcomes, and issue resolution.
• Project management or strong project coordination experience required, including timelines, milestones, risks, roadblocks, stakeholder updates, enhancement tracking, implementation support, post-launch follow-up, and closure.
• Experience creating or supporting user guides, job aids, release notes, FAQs, training materials, stakeholder communications, or rollout support materials preferred.
• Strong Excel and presentation skills required; experience with SharePoint, Power BI, workflow tools, quality management systems, issue tracking tools, reporting tools, or technology-enabled operational platforms preferred.

Knowledge and Skills:

• Strong understanding of healthcare audit operations, quality workflows, quality business processes, reporting needs, and operational support needs within Payment Integrity.
• Strong analytical, problem-solving, organization, prioritization, documentation, follow-up, and stakeholder management skills.
• Able to understand workflow logic, business rules, audit process steps, how work moves through the quality operation, reporting outputs, testing results, and operational impacts.
• Ability to think strategically and translate quality priorities into clear project plans, workflow solutions, quality controls, and sustainable operating practices.
• Communicates clearly through written updates, verbal discussions, presentations, testing summaries, risk updates, action items, and recommendations.
• Collaborates effectively with onshore quality teams, offshore quality partners, configuration, MIS, reporting, training, technology partners, and end users to maintain consistent quality workflows that support operational needs.
• Results-oriented self-starter who can independently own assigned work, execute testing and validation activities, drive workflow improvements, strengthen quality controls, improve outcomes, support scalable operations, and deliver work on time.

The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.