Proof, not promises.
Real engagements across health plans, payers, and health systems. Client names are withheld by agreement; the work speaks for itself. Select any engagement to read the full story.
Regional health plan · Multi-year
Core Platform Migration
$28M annual savings · 600K+ members migrated
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Client Context
A regional health plan undertook a multi-year enterprise transformation: migrating billing, enrollment, and claims onto a new core platform across more than ten interdependent workstreams, with phased member transitions to protect continuity of coverage.
What the Client Needed
- Enterprise governance across 10+ interdependent workstreams
- A phased migration approach for 600K+ members that avoided disruption
- Disciplined SIT and UAT sustained across a multi-year timeline
- Executive visibility into risk, cost, and value realization
- Confidence in each go-live before committing members
Capabilities Demonstrated
Enterprise Governance
We create order at scale.
- Established governance across 10+ workstreams
- Aligned dependencies, ownership, and decision paths
- Kept leadership informed on risk, cost, and value
OutcomeA coordinated, multi-year program operating as one.
Phased Member Migration
We move members without moving the ground beneath them.
- Led phased core platform migration for 600K+ members
- Sequenced transitions to protect continuity of coverage
- Validated readiness before each population moved
OutcomePhased go-lives completed with minimal member disruption.
SIT/UAT Leadership
We make quality the gate, not the afterthought.
- Directed system and user acceptance testing over three years
- Built traceability across billing, enrollment, and claims
- Held releases to a clear readiness bar
OutcomeQuality and readiness sustained across every release.
Business Value Delivered
- $28M in annual cost savings
- $19M in additional value on track
- 600K+ members migrated across billing, enrollment, and claims
- 10+ workstreams delivered under unified enterprise governance
- Phased go-lives with minimal operational disruption
Why Projé
- Enterprise-scale program leadership
- Multi-year delivery discipline
- Governance across complex, interdependent workstreams
- Calm, measured execution under sustained pressure
We lead enterprise migrations end to end, so health plans modernize core platforms with confidence, control, and measurable savings.
Regional health plan · Multi-year
PBM Re-Implementation & Real-Time Data Exchange
Near real-time PBM integration, ready to scale
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Client Context
The plan set out to modernize its PBM integration to replace antiquated batch processes, enable real-time data exchange, improve operational efficiency, and create a scalable platform for growth. The initiative was foundational to supporting ASO expansion, improving member experience, and positioning the organization for future PBM relationships.
What began as a technical re-implementation quickly became a complex, multi-party transformation involving the plan, a national PBM, and a systems integrator, each with competing priorities, constraints, and dependencies.
What the Client Needed
- A single point of leadership across the plan, the PBM, and a systems integrator
- Executive-ready guidance following a vendor-led assessment
- Contract and scope orchestration across multiple vendors
- Program structure for six interdependent initiatives
- Risk management for unproven tools and aggressive timelines
- Delivery discipline across internal, vendor, and PBM teams
- A modernization path without destabilizing core operations
This was not a project-management problem; it was an enterprise orchestration challenge.
Capabilities Demonstrated
Executive Program Leadership in Complex Ecosystems
We lead across organizations, not just within them.
- Oversight of plan, PBM, and vendor project teams
- Direct reporting from plan, vendor, and PBM project managers
- Executive-level communication and governance
- Steering committee facilitation and decision support
OutcomeA single, trusted program leader aligning three organizations around one plan.
Vendor Strategy, Contracting & Scope Control
We protect the client while keeping momentum.
- Guided vendor assessment and executive presentation
- Facilitated SOW creation across business, IT, and legal
- Managed multi-cycle redlines and negotiations
- Led scope changes and contract renegotiation
- Prevented overengineering and misaligned investment
OutcomeThe plan retained control of cost, scope, and risk while still leveraging vendor expertise.
Real-Time PBM Integration Enablement
We modernize health plan data exchange without breaking operations.
- Implemented near real-time accumulator synchronization
- Enabled API-based pharmacy data for portals and mobile apps
- Transitioned eligibility and billing to NCPDP standards
- Re-established system-of-record boundaries (PBM vs. core claims)
- Eliminated error-prone batch and manual processes
OutcomeA scalable, modern PBM integration model ready for growth.
Business Value Delivered
- Near real-time accumulator synchronization, reducing member overcharges and improving accuracy across medical and pharmacy
- Real-time pharmacy data in member and broker portals
- NCPDP-standard billing files that reduced PBM maintenance burden and simplified internal processing
- Streamlined internal PBM data operations
- Platform readiness for onboarding future PBMs
- Enabled ASO program designs previously unsupported
- Improved member satisfaction and transparency
Why Projé
- Health plan operations expertise
- Deep understanding of claims and PBM ecosystems
- Executive-grade program leadership
- Vendor and contract fluency
- Calm, disciplined execution in high-risk environments
We don't just run programs. We orchestrate complex transformations, aligning business, IT, vendors, and partners so health plans can modernize without destabilizing the enterprise.
National nonprofit managed care organization · Multi-year
Medicaid New Market Implementation
All contractual services live by the January deadline
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Client Context
A national, nonprofit managed care organization was awarded a State Medicaid contract to operate effective January 1, 2026, a new market entry that required standing up a fully compliant Medicaid operation across an entire state.
The award came with extraordinary pressure: notice in March, contract in May, Open Enrollment by October, and full operational readiness by January, all while the organization managed multiple enterprise initiatives sharing the same go-live date. This was not a typical implementation; it was an enterprise mobilization under extreme time constraints.
What the Client Needed
- Rapid translation of contractual requirements into executable scope
- A unified enterprise program structure across siloed teams
- Clear ownership, accountability, and dependency management
- Executive alignment on risks, decisions, and trade-offs
- Confidence that all regulatory and operational requirements would be met
- Readiness for Open Enrollment and full operational go-live
Key challenges included a compressed nine-month window, Open Enrollment readiness by October 1, dozens of contractual capabilities required at go-live, competing enterprise priorities on the same deadline, and fragmented teams operating without shared visibility.
Capabilities Demonstrated
Contract-to-Execution Translation
We turn regulatory language into operational reality.
- Interpreted State contract requirements
- Translated obligations into actionable scope and workstreams
- Partnered with market leaders, compliance, and the State
- Ensured nothing critical was missed or misinterpreted
OutcomeA clear, executable implementation plan aligned to contractual obligations.
Enterprise Program Architecture
We create order at scale.
- Designed the end-to-end program structure
- Established workstreams, ownership, and resource models
- Clarified roles, dependencies, and decision paths
- Aligned siloed teams under a single operating model
OutcomeA unified enterprise program operating as one team.
Executive Visibility & Governance
We give leaders confidence.
- Structured governance and steering cadence
- Delivered executive-ready reporting on risks, milestones, and decisions
- Created transparency across scope, dependencies, and trade-offs
- Enabled timely leadership action
OutcomeLeadership stayed informed, aligned, and decisive throughout execution.
High-Velocity Execution
We deliver under pressure.
- Maintained momentum across competing enterprise initiatives
- Managed cross-team dependencies
- Identified and mitigated risks early
- Kept the organization focused on what mattered most
OutcomeA high-confidence path to market readiness.
Business Value Delivered
- Full implementation of all contractually required services by January 1
- Organizational readiness for Open Enrollment on October 1
- Compliance with all contractual requirements and SLAs
- Stable post-launch operations with key indicators remaining green
- Enterprise alignment across leadership and delivery teams
Why Projé
- Deep Medicaid and government program fluency
- Contract interpretation and regulatory rigor
- Enterprise program architecture
- Executive-level communication and governance
- Calm, disciplined execution in high-stakes environments
We don't just manage implementations. We mobilize enterprises, so health plans can enter new markets with confidence, speed, and control.
Regional health plan · Multi-year
Senior Health Services & Enterprise Data Transformation
Stabilized delivery and audit-ready data quality
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Client Context
This regional plan serves a complex Senior population while balancing coordinated care, cost containment, and regulatory rigor. During a multi-year transformation, the organization ran multiple concurrent initiatives to modernize its data ecosystem, stabilize delivery, strengthen Senior Health Services (SHS) operations, and improve Business-IT alignment.
The environment included legacy platforms, evolving vendor integrations, DevOps delivery, and rising regulatory and quality demands. Proje served as a long-term extension of the SHS, enterprise data, QA, and delivery leadership teams.
What the Client Needed
- Enterprise data migration dependencies were blocking downstream application work
- Vendor integrations had no documented current state
- DevOps delivery lacked QA governance, environments, and automation
- Agile execution was breaking down due to weak requirements and testing rigor
- Ownership was fragmented across business, IT, vendors, and data domains
- Operational frustration was growing and confidence in delivery was declining
These were not isolated project issues; they represented enterprise capability gaps across execution, data trust, and quality.
Capabilities Demonstrated
Enterprise Operational & IT Current-State Intelligence
We make the invisible visible.
- Rapid deep-dive assessments across SHS, enterprise data, IT, and vendors
- End-to-end process, data flow, and dependency mapping
- Identification of systemic root causes across people, process, technology, and data
- Creation of a shared, authoritative single version of truth
OutcomeLeadership gained immediate clarity into what existed, where execution was breaking down, and what needed to change.
Data Platform & Integration Enablement
We modernize how health plans ingest, govern, and trust data.
- Designed automated vendor data ingestion patterns (Informatica)
- Ensured high-quality, consistent downstream data consumption
- Aligned architecture, requirements, and onboarding across teams
- Built scalable integration patterns to support future growth
OutcomeA reliable, governed data pipeline enabling coordinated care programs and regulatory reporting.
Delivery Enablement & Execution Discipline
We stabilize execution without slowing momentum.
- Coached teams on actionable requirements and acceptance criteria
- Re-established SDLC and agile best practices in real-world conditions
- Clarified roles, responsibilities, and cross-workstream dependencies
- Reset scope, cadence, and expectations at initiative outset
OutcomeTeams delivered within sprint, reduced rework, and regained predictability.
QA Transformation & Environment Strategy
We turn quality into a capability, not a bottleneck.
- Designed QA governance models where none existed
- Defined Unit, SIT, and UAT environment strategies
- Introduced automated testing into data platforms (Tricentis Tosca)
- Delivered HEDIS-aligned testing strategies and documentation
- Standardized reusable QA artifacts and workflows
OutcomeFaster delivery, audit-ready quality, and restored confidence in release readiness.
Data Stewardship, Governance & Business Architecture
We align strategy, data, and execution.
- Served as data stewards bridging Business and IT
- Validated vendor feeds, PHI controls, and governance requirements
- Translated complex technical designs for non-technical stakeholders
- Developed Business Capability Models and maturity heatmaps
- Connected process gaps and technical debt to capability prioritization
OutcomeEnterprise-wide trust in data and a shared Business-IT prioritization framework.
Business Value Delivered
- Immediate visibility into operational health across SHS and enterprise data
- Stabilized delivery across complex, multi-vendor programs
- Reduced rework and missed sprints through improved requirements and QA
- Modernized, automated, and governed vendor data ingestion
- Strengthened PHI compliance and regulatory readiness
- Repeatable execution patterns for future initiatives
- Rebuilt trust between Business, IT, and data teams
Why Projé
- Deep health plan and Senior Health Services operational fluency
- Enterprise data and vendor ecosystem mastery
- QA transformation and automation expertise
- Business architecture and capability modeling
- Practitioner-led execution with executive-level communication
We don't just support programs. We build durable execution capability inside complex health plans, so leaders regain clarity, risk surfaces early, and transformation actually sticks.
National health plan payer · Multi-year
Health Plan Acquisition Integration
Continuity of care preserved through a phased, low-risk transition
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Client Context
A national health plan payer with existing state and federal programs was selected to expand its footprint through the state-coordinated acquisition of a financially troubled but operationally critical health plan serving Dual Eligible and Special Needs populations.
The acquisition required rapid integration planning across people, processes, platforms, vendors, and regulatory obligations, while maintaining continuity of care and meeting state and federal requirements. Proje was engaged to lead the integration infrastructure and enterprise workstreams spanning joint planning, assessment, and phased execution across both organizations.
What the Client Needed
- Enterprise-level leadership to coordinate a complex acquisition integration
- Rapid assessment of business, financial, clinical, and technology practices
- Clarity on the disposition of thousands of vendor contracts
- A phased transition strategy that reduced risk and protected operations
- Alignment across 20+ business and IT workgroups
- Confidence that government program obligations would remain intact
Key challenges included 3,000+ vendor contracts with incomplete or undocumented terms, limited visibility into the acquired entity's operational and financial exposure, tight state-driven timelines, and the need to separate near-term stabilization from longer-term systems integration. This was not a traditional M&A integration; it was a high-risk, government-regulated enterprise transition.
Capabilities Demonstrated
Enterprise Program & Delivery Leadership
We lead integration at enterprise scale.
- Established and led the integration team infrastructure
- Designed and governed cross-enterprise workstreams
- Enhanced existing implementation structures, artifacts, and protocols
- Maintained executive visibility into milestones, risks, and decisions
OutcomeA disciplined, coordinated integration effort operating under a single execution model.
Operational & IT Current-State Intelligence
We create clarity before decisions are made.
- Assessed business, financial, clinical, and technology practices
- Evaluated vendor, provider, and partner relationships
- Identified risks, dependencies, and decision points
- Informed disposition planning for integration vs. exit
OutcomeFact-based decisioning that balanced speed, risk, and financial impact.
Government Program Expertise
We protect regulated programs during transition.
- Ensured continuity of integrated dual-eligible care programs serving tens of thousands of members
- Maintained care management and compliance integrity
- Aligned transition sequencing with regulatory expectations
OutcomeGovernment program stability throughout acquisition and transition.
Claims & Core Platform Transition Planning
We sequence change to reduce disruption.
- Planned phased platform and operational transitions
- Identified dependencies for configuration, data migration, and IT handoff
- Separated Wave 1 stabilization from Wave 2 systems integration
OutcomeReduced operational risk while enabling future-state transformation.
Business Value Delivered
- Timely, contract-driven vendor disposition decisions resulting in financial savings
- Successful Wave 1 transition of Financial, HR, Legal, and Compliance functions
- Clear, dependency-aware planning for the Wave 2 systems and operations transition
- Improved efficiency and decision speed through AI-assisted analysis
- Strong working relationships across parent and acquired organizations
Why Projé
- Enterprise integration leadership in regulated environments
- Deep understanding of government-sponsored health programs
- Practitioner-led assessment and execution
- Ability to operate calmly in high-risk, high-visibility transitions
We don't just integrate organizations. We stabilize what matters first, then enable what's next, ensuring continuity of care, regulatory confidence, and execution you can trust.
Large national non-profit health plan · Multi-year
HIDE-SNP Implementation
A compliant, fully integrated dual-eligible plan, launched
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Client Context
The client launched a Highly Integrated Dual Eligible Special Needs Plan (HIDE-SNP) to deliver fully integrated Medicare, Medicaid, and Long-Term Services and Supports (LTSS) benefits for dual-eligible members in the Midwest. The program required deep coordination across CMS, a state Department of Health and Human Services, Prepaid Inpatient Health Plans (PIHPs), LTSS providers, and community-based organizations.
Strategically critical to expanding in the fast-growing dual-eligible market, the initiative demanded flawless execution. Proje partnered in a co-delivery model to translate regulatory complexity into a fully operational, compliant, and scalable program.
What the Client Needed
- End-to-end leadership for a highly regulated, multi-payer product launch
- Translation of CMS and state requirements into executable operations
- Integration of medical, LTSS, and behavioral health care models
- Claims, encounters, pharmacy, and eligibility synchronization across Medicare and Medicaid
- Readiness for CMS and state reviews, audits, and ongoing oversight
- Scalable infrastructure to support future dual-eligible growth
Key challenges included dual Medicare-Medicaid compliance, coordination with carved-out behavioral health entities, LTSS provider contracting and HCBS compliance, eligibility and cost-sharing complexity, and systems readiness across claims, care management, encounters, and reporting.
Capabilities Demonstrated
Government Program & Market Implementation
We deliver when regulatory complexity is highest.
- Translated CMS and state HIDE-SNP requirements into actionable business rules
- Supported readiness reviews, audits, and ongoing compliance
- Ensured alignment with state-specific integration standards
OutcomeA compliant, fully operational HIDE-SNP ready for launch and sustained oversight.
Enterprise Program & Delivery Leadership
We orchestrate across silos and stakeholders.
- Established structured governance, RAID management, and execution cadence
- Led cross-functional and cross-organizational coordination
- Enabled rapid decision-making through weekly integrated forums
OutcomeUnified execution across medical, LTSS, behavioral health, IT, and compliance teams.
Claims & Core Platform Optimization
We make integrated benefits operationally real.
- Directed configuration and validation of Medicare, Medicaid, and LTSS claims rules
- Ensured pricing, edits, accumulators, and wrap payments met regulatory standards
- Coordinated dependencies across Claims, Provider Contracting, and IT
OutcomeAccurate claims processing and reduced downstream reconciliation risk.
Data Platform, Integration & Interoperability
We enable compliant, connected data exchange.
- Oversaw encounter mapping, validation, and state submissions
- Implemented controls to reduce rejections and strengthen data integrity
- Led development of FHIR-based clinical data extracts
- Ensured alignment with CMS payer-to-payer and patient access APIs
OutcomeReliable reporting, interoperability compliance, and audit-ready data pipelines.
QA Transformation & Testing Excellence
We embed confidence before go-live.
- Led end-to-end testing across operations, systems, and workflows
- Validated regulatory requirements through integrated test scenarios
- Ensured workflows were sustainable in production
OutcomeLaunch readiness with reduced post-go-live disruption.
Business Value Delivered
- Successful launch of an integrated HIDE-SNP program
- Expanded presence in the dual-eligible market with a differentiated, integrated offering
- Stable, risk-adjusted Medicare and Medicaid revenue streams
- Improved care coordination across medical, LTSS, and behavioral health
- Strengthened enterprise capabilities for complex government programs
- A foundation for future D-SNP, LTSS, and integrated product expansion
Why Projé
- Deep expertise in Medicare, Medicaid, and dual-eligible programs
- Proven leadership in high-stakes regulatory launches
- Practitioner-led translation of policy into operations
- Calm, disciplined execution across complex care ecosystems
We don't just launch government programs. We build integrated, compliant models that perform in the real world, with execution you can trust when it matters most.
Large regional non-profit health plan (1M members) · Multi-year
Claims System Assessment & Optimization
$40M+ core-replacement cost avoided
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Client Context
A nationally recognized non-profit health plan serving one million members sought to improve the performance and integrity of its core claims platform. Leadership faced a pivotal question: should we replace the system, or can we fix what we have? The answer required deep operational, technical, and financial insight.
What the Client Needed
- High claim pends and manual adjustments
- Enrollment fallouts causing delays, dissatisfaction, and contract risk
- Recurring provider data and fee schedule errors
- Non-standard product configurations driving rework and inconsistency
- No authoritative provider source of truth
- Weak QA and environment management causing production instability
- Executive uncertainty about whether to replace the core claims system
These were not isolated defects; they reflected enterprise execution and integrity gaps.
Capabilities Demonstrated
Enterprise Operational Intelligence
We rapidly diagnosed root causes across people, process, technology, and data.
- Field-tested, metrics-driven assessment methodology
- Intensive discovery across operations, IT, leadership, and vendors
- Scored current-state evaluation across organizational alignment, process, and systems
- Clear prioritization of what mattered most
OutcomeA fact-based, enterprise-wide understanding of where performance was breaking down, and why.
Value-Driven Transformation Roadmapping
We translate insight into executable strategy.
- Two-year, prioritized remediation roadmap
- Financial model tied to each initiative
- Sequencing designed to deliver near-term wins and mid-term transformation
OutcomeA practical, board-ready plan aligning operations, IT, and finance around a shared path forward.
Claims & Configuration Optimization
We modernize how the platform is used, without replacing it.
- Standardized master product templates to enable reuse and reduce manual work
- Automated provider contracts and benefit changes using native platform capabilities
- Established QA rigor and environment discipline
- Reduced operational risk through standardization and automation
OutcomeA more stable, scalable, and trustworthy claims operation.
Business Value Delivered
- Reduced claim pends by 5%+
- Cut code-red production incidents by 50%
- Eliminated the need for core system replacement, a $40M+ cost avoidance
- Reduced audit exposure, a projected $1.25M/year savings
- Reduced reliance on temporary labor, a projected $1.75M/year savings
- Increased provider payment accuracy and enrollment integrity
- Restored confidence in the platform and operating model
Why Projé
- Deep health plan operations expertise
- Core claims system mastery
- Enterprise assessment rigor
- Practitioner-led transformation
We don't just evaluate systems. We unlock the value inside them, helping health plans stabilize operations, avoid unnecessary replacement, and build lasting execution capability.
Large multi-line health plan · Multi-year
Enterprise Operational & Claims Ecosystem Assessment
A surgical modernization plan replacing a high-risk overhaul
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Client Context
A large, multi-line health plan entered a period of transformation under new executive leadership and a new business strategy. Growth ambitions across Commercial and Government programs were constrained by operational fragility, limited digital capability, and uncertainty about the true health of the claims ecosystem.
Leadership was considering a costly re-install of the core claims platform without a clear understanding of upstream and downstream dependencies, placing a multi-million-dollar investment at significant risk. Executives needed clarity, alignment, and a fact-based path forward.
What the Client Needed
- Executive visibility into the root causes of operational inefficiency
- A shared understanding of the business capabilities required to support the new strategy
- Alignment between Business and IT on priorities and investment decisions
- Insight into the true complexity of the core claims ecosystem and its dependencies
- A path to modernize operations without destabilizing the enterprise
- An alternative to a high-risk, full-platform replacement
Operational symptoms included high claims pends, manual paper-heavy enrollment (20%+ of volume), limited digital self-service, manual claims review outside the platform, reconciliation failures between Medicare enrollment and claims systems, and a lack of automation, all symptoms of systemic capability gaps.
Capabilities Demonstrated
Enterprise Operational Intelligence
We make complexity visible and actionable.
- Intensive discovery across all lines of business
- End-to-end review of processes, data, and enabling technologies
- Categorization of gaps by complexity and impact
- Immediate transparency into operational health
OutcomeLeadership gained a clear, shared understanding of what was broken, and why.
Claims Ecosystem & Technical Debt Mapping
We illuminate what truly exists.
- Comprehensive inventory of all systems, tools, and data sources supporting the platform
- Holistic view of upstream and downstream dependencies
- Fact-based understanding of operational and architectural risk
OutcomeA single, authoritative reference of the claims ecosystem and its fragility.
Business Architecture & Capability Alignment
We align strategy to execution.
- Developed a Business Capability Model aligned to the new strategy
- Built a maturity heatmap across critical capabilities
- Connected process gaps and technical debt to capability maturity
- Established a shared Business-IT prioritization framework
OutcomeFor the first time, Business and IT aligned around which capabilities mattered most and where to invest.
Risk-Optimization Modernization Strategy
We replace big-bang with precision.
- Defined targeted remediation, including process automation, technology consolidation, greater use of existing platform capabilities, digital self-service, and vendor rationalization
- Enabled leadership to revise a full-replacement strategy
- Shifted to a lower-risk, surgical modernization approach
OutcomeThe client avoided an unnecessarily high-risk overhaul and adopted a smarter, staged path forward.
Business Value Delivered
- Enterprise-wide transparency into operational and technical reality
- Business-IT alignment around strategy and investment priorities
- A capability-driven modernization roadmap
- Reduced risk to a multi-million-dollar platform initiative
- A fact-based alternative to full system replacement
- A foundation for scalable, digital, growth-ready operations
Why Projé
- Health plan operational fluency
- Claims platform and ecosystem mastery
- Assessment rigor across people, process, technology, and data
- Business architecture and capability modeling
- Executive-level synthesis and guidance
We don't just diagnose problems. We create clarity, alignment, and momentum, so health plans can modernize with confidence rather than risk.
Leading healthcare solutions provider · Multi-year
Product Modernization, Cloud Transformation & QA Excellence
~$8.65M projected annual savings across modernization
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Client Context
A leading healthcare solutions provider undertook a multi-year transformation to modernize its products, migrate to the cloud, and stand up enterprise-grade quality across mission-critical platforms.
The work spanned product modernization, enterprise QA transformation, cloud migration, and operational stability across a portfolio of interdependent initiatives.
What the Client Needed
- Enterprise quality frameworks to reduce risk across a complex modernization program
- Coordinated leadership across many interdependent initiatives
- Modernization of legacy billing, enrollment, and claims platforms
- Migration of core products and infrastructure to the cloud
- A path to reduce technical debt and realize measurable savings
Twelve interdependent projects had to advance together without destabilizing mission-critical healthcare platforms.
Capabilities Demonstrated
QA Transformation & Testing Excellence
We establish enterprise quality frameworks that reduce risk and improve delivery confidence.
- Program-level testing strategy spanning 12 interdependent projects
- Integrated SIT and UAT coordination across modernization initiatives
- Comprehensive enterprise use-case scenarios and quality measures
- Structured testing governance, defect management, and readiness oversight
- Quality coordination across infrastructure, cloud migration, application modernization, and code consolidation
- Go-live readiness through cross-functional testing and risk-mitigation planning
OutcomeImproved enterprise delivery quality, reduced operational risk, and stable modernization deployments.
Enterprise Program & Delivery Leadership
We bring structure, governance, and execution discipline to large-scale transformations.
- Program leadership across 12 interdependent initiatives
- Coordinated multiple project managers within the client PMO framework
- Integrated schedules aligned to dependencies, milestones, and resources
- Scope, budget, RAID management, and executive reporting
- Cross-functional coordination across business, infrastructure, development, and operations
OutcomeA coordinated transformation program delivered with strong governance and organizational alignment.
Claims & Core Platform Optimization
We modernize platforms to improve scalability, performance, and efficiency.
- Modernized billing, enrollment, and claims product platforms
- Consolidated client-specific code bases into standardized enterprise frameworks
- Improved scalability, stability, and system performance
- Decommissioned legacy ETL and integration components
OutcomeA simplified, scalable operating environment supporting efficiency and future growth.
Data Platform, Integration & Interoperability
We modernize integration and cloud capabilities for resilience and performance.
- Directed migration of core products and infrastructure to the cloud (Microsoft Azure)
- Coordinated upgrades across .NET, Informatica, BizTalk, Oracle, and SQL Server technologies
- Automated infrastructure monitoring, batch controls, and notification workflows
- Enabled client product-configuration self-service
OutcomeA secure, cloud-enabled environment with improved monitoring, integration performance, and reliability.
Strategic Value Realization & Operational Transformation
We connect modernization to measurable operational and financial outcomes.
- Reduced technical debt and operational redundancies across the portfolio
- Automated development operations and infrastructure management
- Improved provider and member portal performance through user-centric enhancements
- Modernized cloud-hosted BPaaS solutions supporting government healthcare programs
OutcomeProjected annualized savings of approximately $8.65M.
Business Value Delivered
- Enterprise QA oversight across 12 interconnected modernization projects
- Core healthcare products and infrastructure migrated to cloud hosting
- Modernized enterprise application architecture and integration technologies
- Multiple product code bases consolidated into standardized platforms
- Automated monitoring and operational controls for mission-critical systems
- Improved scalability, stability, testing governance, and efficiency
- Projected ~$8.65M in annual savings through modernization and optimization
Why Projé
- Deep healthcare operational expertise
- Enterprise QA leadership
- Disciplined program execution
- Governance and testing rigor in highly integrated environments
We don't just test systems; we create confidence in enterprise readiness, delivery quality, and operational outcomes.
National third-party administrator (TPA) · Multi-year
Core Platform Conversion & QA Transformation
~20M records converted at a 0.3% error rate
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Client Context
A national third-party administrator replaced its core administration platform, a high-risk conversion touching enrollment, claims, authorizations, accumulators, and member data.
The organization had no formal QA department, so quality and readiness had to be built as the conversion was executed.
What the Client Needed
- Foundational UAT and QA processes where none existed
- A program-level test strategy spanning operational and technical domains
- Large-scale data validation and conversion quality controls
- Coordinated delivery across operational, technical, and testing teams
- Reduced manual effort and contractor dependency through automation
The conversion had to preserve operational continuity while moving tens of millions of records accurately.
Capabilities Demonstrated
QA Transformation & Testing Excellence
We establish scalable quality frameworks that reduce risk during complex transformations.
- Built the organization's foundational UAT and QA processes where no QA department existed
- Created testing templates, governance standards, scripts, guides, and execution tools
- Developed a program-level test strategy and integrated test plan across domains
- Designed use-case scenarios validating enrollment, claims, authorizations, accumulators, and member-data conversion
- Coordinated enterprise testing and stakeholder readiness
OutcomeA repeatable QA and UAT framework that improved consistency, readiness, and delivery confidence.
Claims & Core Platform Optimization
We modernize and stabilize core platforms while preserving continuity.
- Led enterprise conversion execution to the new core platform
- Directed migration of enrollment, claims, authorizations, accumulators, and notes
- Coordinated large-scale data validation and conversion quality controls
- Supported stabilization and operational transition to the new environment
OutcomeApproximately 20 million records converted at a 0.3% error rate, supporting a stable, accurate transition.
Enterprise Program & Delivery Leadership
We provide structure, governance, and execution discipline.
- Integrated program schedules aligned to deliverables, resources, and timing
- Identified cross-functional dependencies and built them into execution plans
- Managed delivery coordination across operational, technical, and testing teams
- Supported oversight through structured planning, tracking, and communication
OutcomeCoordinated execution across multiple workstreams aligned to business priorities and timelines.
Operational & IT Current-State Intelligence
We identify inefficiencies and implement scalable improvements.
- Evaluated manual extraction and validation processes
- Automated extraction supporting operational efficiency
- Reduced contractor dependency through automation and workflow optimization
- Introduced scalable operational controls for long-term sustainability
OutcomeAutomation reduced the need for three contractor resources while improving consistency.
Business Value Delivered
- Successful enterprise conversion to a new core administration platform
- Approximately 20 million records converted with a 0.3% error rate
- Formal UAT and QA governance established for the organization
- Improved enterprise testing consistency and operational readiness
- Automated extraction workflows reducing overhead and contractor reliance
- A more scalable, controlled operational environment for future growth
Why Projé
- Deep healthcare operational expertise
- Enterprise QA leadership
- Disciplined program execution
- Operational insight that reduces risk during mission-critical implementations
We don't just support conversions; we create confidence in the quality, readiness, and long-term stability of enterprise transformation.
Health plan (2M+ members) · Multi-year
Care Management Assessment & Implementation
A troubled UM/CM implementation course-corrected and re-planned
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Client Context
A health plan serving more than two million members set out to increase operating margin and improve member experience by implementing a Care Management Platform to manage clinical information, coordinate care delivery, and collaborate with providers.
Proje was engaged using an agile approach to standardize and streamline business processes, provide technical strategy and vendor oversight, and course-correct a multi-year, enterprise-critical utilization- and care-management (UM/CM) implementation.
What the Client Needed
- Program and business-analysis leadership for a strategic transformation
- Technical strategy and oversight across multiple vendors
- Operational readiness for future-state processes, including change management and testing oversight
- A realistic, scalable plan to recover a troubled implementation
- A roadmap to address the interface backlog and prepare teams for migration
Frequent leadership changes and skill-set gaps had stalled the program and put an enterprise-critical investment at risk.
Capabilities Demonstrated
Enterprise Program & Delivery Leadership
We bring structure and a scalable agile approach to recover complex programs.
- Restructured the care-management implementation with a scalable agile program plan
- Designed a program structure and organization model
- Managed budget, resources, and risk mitigation with executive reporting
- Built short-term (3-6 month) and long-term (6-18 month) recovery plans
OutcomeA course-corrected program with executive visibility and a realistic path forward.
Technical Advisory & Vendor Oversight
We give clients control across complex vendor ecosystems.
- Provided technical strategy and oversight across platform and systems-integration vendors
- Defined a technical and testing approach
- Coordinated the core-claims and care-management platform interface backlog
OutcomeA clear technical direction and disciplined vendor coordination.
Operational Readiness
We prepare the organization, not just the system.
- Completed current- and future-state business and technical readiness assessments
- Led change management, testing oversight, analytics, and letters/reports evaluation
- Prepared the care-management team for platform migration
OutcomeTeams and processes ready for the future-state operating model.
Care Management Transformation
We connect clinical strategy to operational execution.
- Standardized and streamlined care-management business processes
- Created a roadmap of optimization opportunities
- Aligned clinical, operational, and technical stakeholders
OutcomeA coordinated path to better care coordination and operating performance.
Business Value Delivered
- A course-corrected, enterprise-critical care-management implementation
- A scalable agile program structure with executive reporting
- Short- and long-term recovery roadmaps with focused change-management plans
- A methodology to address the platform interface backlog
- A prepared, migration-ready care-management team
- Foundations to increase operating margin and improve member experience
Why Projé
- Health plan operational fluency
- Program leadership and agile recovery experience
- Technical advisory and vendor management
- Operational readiness and change-management discipline
We don't just manage projects; we course-correct enterprise-critical programs, restoring structure, confidence, and a path to value.