Program Manager, Healthcare Payer Operations and Technology

Job Description

A leading organization is seeking a Program Manager with deep healthcare payer experience to lead multiple concurrent initiatives across business and technology teams. This position requires a strong leader who can drive project execution, establish structured delivery plans, manage dependencies, and ensure alignment across stakeholders while supporting business transformation efforts.

Responsibilities

• Lead and coordinate multiple complex projects and enterprise programs with overlapping dependencies.
• Develop and maintain detailed Work Breakdown Structures (WBS), project plans, milestones, ownership models, and delivery schedules.
• Translate strategic business objectives into actionable program roadmaps and execution plans.
• Partner with business and technology teams to ensure clear communication, alignment, and successful delivery outcomes.
• Document and analyze business processes, workflows, and impacts across people, processes, and technology.
• Oversee project governance activities, status reporting, issue management, and dependency tracking.
• Identify, assess, and mitigate operational, technical, regulatory, and delivery risks.
• Drive execution across initiatives while removing obstacles and accelerating progress toward program goals.
• Support implementation efforts involving emerging technologies, including artificial intelligence, machine learning, and large language model solutions.
• Coordinate with internal stakeholders, external vendors, and cross-functional leadership teams to ensure successful program outcomes.
• Operate effectively within Agile, Scrum, SAFe, Waterfall, and blended delivery environments.

Required Experience and Skills

• Extensive program management experience leading large-scale business and technology initiatives.
• Strong healthcare payer domain expertise, including health insurance, managed care operations, member engagement platforms, and CRM-related programs.
• Demonstrated ability to manage multiple high-complexity projects simultaneously.
• Advanced expertise in Work Breakdown Structure (WBS) development, project planning, milestone management, and execution oversight.
• Experience leading programs that incorporate artificial intelligence, machine learning, or large language model technologies to improve business processes or operational performance.
• Strong understanding of system integration concepts and the ability to work effectively with technical teams.
• Proven process-mapping and systems-thinking capabilities that evaluate organizational, operational, and technical impacts.
• Experience with proactive risk identification, mitigation planning, and issue resolution.
• Track record of delivering results in fast-paced environments while making data-driven decisions.
• Strong stakeholder management, executive communication, and vendor management skills.
• Experience applying Agile, Scrum, SAFe, Waterfall, and hybrid project delivery methodologies.
• Ability to bridge business and technology teams and drive collaboration across diverse functional groups.

FAQ

1. What does a Program Manager in Healthcare Payer Operations and Technology do?

A Program Manager oversees complex initiatives that improve healthcare payer operations, technology systems, and business processes. The role coordinates multiple workstreams, manages delivery risks and dependencies, and ensures technology initiatives support operational, regulatory, and member-service objectives.

2. What types of payer programs might this role manage?

Programs may involve claims administration, member enrollment, provider operations, utilization management, care management, payment systems, digital member platforms, data modernization, and regulatory technology initiatives. The role often coordinates several related projects toward a common business outcome.

3. How does this role support healthcare payer technology modernization?

The Program Manager helps coordinate modernization of legacy applications, data platforms, workflows, and operational systems. They align technology delivery with business priorities while managing timelines, dependencies, resources, and implementation risks.

4. How does a Program Manager work with healthcare payer stakeholders?

The role typically partners with operations leaders, product managers, technology teams, clinical stakeholders, compliance, finance, vendors, and executive sponsors. Effective coordination ensures business requirements are understood, technology delivery remains aligned, and issues are resolved across workstreams.

5. What role does regulatory compliance play in payer technology programs?

Healthcare payer programs often involve requirements related to privacy, security, reporting, claims processing, and government or contractual obligations. The Program Manager coordinates with compliance and subject-matter teams to ensure these requirements are incorporated into planning, implementation, testing, and delivery.

6. How are program risks and dependencies managed?

The Program Manager maintains visibility into cross-project risks, issues, assumptions, decisions, and dependencies. They develop mitigation plans, coordinate owners, monitor impacts to timelines or scope, and escalate significant concerns to appropriate leadership.

7. What metrics are used to measure healthcare technology program success?

Program performance may be measured through milestone completion, budget adherence, operational efficiency, defect rates, system adoption, claims or transaction processing performance, regulatory readiness, and achievement of defined business outcomes. The specific measures depend on the program objectives.