We are seeking an experienced and strategic Product Manager with deep expertise in the Healthcare Payer domain to join our team as a Subject Matter Expert (SME).

The successful candidate will play a pivotal role in driving business requirements, solution design, and collaboration across stakeholders to ensure delivery of impactful projects that meet healthcare payer business needs and compliance standards.

Responsibilities

Act as a Subject Matter Expert for Healthcare Payer processes, operations, and regulations
Define detailed business requirements, use cases, and functional specifications by engaging with stakeholders across payers, providers, and other healthcare entities
Develop process flows and gap analysis to identify opportunities for system enhancements and operational efficiencies
Collaborate effectively with IT, QA, and business units to ensure project deliverables meet scope and specifications
Facilitate workshops and stakeholder meetings to gather insights and validate requirements
Provide clear and concise documentation that translates complex healthcare payer processes for technical teams
Lead testing strategy activities by creating test cases and participating in user acceptance testing (UAT)
Stay informed of healthcare regulatory updates and payer industry trends, including CMS guidelines and emerging technologies
Offer SME insights during system implementation to verify compliance and business alignment
Support training initiatives and change management efforts to drive solution adoption

Requirements

Bachelor's degree in Computer Science, or related field, with preference for Master's degree
10-16 years of experience in the Healthcare Payer domain as a Business Analyst or Product Manager
Expertise in healthcare payer operations including claims processing, member management, provider networks, and benefit plans
Knowledge of regulatory compliance standards such as CMS guidelines, ACA, and HIPAA requirements
Background in payer systems encompassing enrolment, billing, claims management, and provider portals
Showcase of strong analytical, problem-solving, and documentation capabilities
Competency in stakeholder communication and management skills
Familiarity with Agile/Scrum methodologies
Proficiency in Business Analysis tools and techniques

Nice to have

Certified Business Analysis Professional (CBAP) or equivalent
Showcase of healthcare-specific certifications such as CHC or CPCO
Understanding of payer-specific IT systems and software solutions

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