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
