Project Manager - Healthcare Claims Management

The Project Manager – Healthcare Claims Management (Subject Matter Expert) is responsible for leading complex projects and initiatives related to claims adjudication, processing, compliance, and operational improvements. This role requires deep subject matter expertise in healthcare claims systems, workflows, and regulatory requirements. The PM will collaborate with cross-functional teams to ensure timely, accurate, and compliant claims operations while driving strategic enhancements.

SALARY: $95,000.00/Annually

JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES

The PM’s responsibilities include but are not limited to:

• Lead and manage end-to-end projects focused on healthcare DME claims.
• Serve as the subject matter expert for claims workflows, system configurations, and industry best practices.
• Oversee requirements gathering, business analysis, and documentation of claims processes.
• Ensure claims-related projects meet compliance with HIPAA, CMS, Medicaid, and other applicable regulations.
• Partner with IT, operations, and vendor teams to resolve system defects, improve processing accuracy, and optimize turnaround times.
• Manage stakeholder communications, project status reporting, and escalation of risks or issues.
• Facilitate user acceptance testing (UAT) for claims-related enhancements and system changes.
• Monitor and track project performance, ensuring deliverables are met within scope, budget, and schedule.

EDUCATION: Bachelor’s degree in healthcare administration, business, or related field, or equivalent experience required.

EXPERIENCE:

• 5+ years of experience in healthcare claims management, with at least 3 years in a project management capacity.
• Deep knowledge of claims adjudication systems (e.g., QNXT, Facets, HealthEdge) and HIPAA EDI transactions (837, 835, 277, 820).
• Proven experience leading cross-functional projects in a payer or managed care environment.
• Strong understanding of CMS, Medicaid, and state-specific claims regulations.
• Excellent communication, organizational, and analytical skills.

Benefits Offered

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance
• Company-paid short term disability coverage (location restrictions may apply)
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO)
• Paid Parental Leave
• Sick Time
• Paid company holidays and floating holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities

Remote Opportunities

We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.

Our Story

Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a wholly owned subsidiary of Point32Health.

With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.

Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.