Director of Product – Network

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate with network, go-to-market, and sales teams to define and outline Nomi’s deliverables for each new market, encompassing provider coverage, TPA capability, and integration sequencing.

• Develop integration requirements between Nomi and its partners across the claims lifecycle, which includes inbound claims, priced output, remittance, eligibility, file cadence, SLAs, and reconciliation.

• Oversee network configuration and pricing from the signed rate sheet to accurately priced claims, including ingestion, normalization, versioning, effective dating, validation, and auditing.

• Establish testing and release standards for changes related to pricing.

• Manage the provider data model and hierarchy, covering sponsor, tax ID, billing NPI, and service location.

• Make network adequacy and directory accuracy quantifiable.

• Assess new group types and market segments, recommending against those that are not a suitable fit.

• Identify payment-related implications of network modifications and coordinate with financial services and payments teams.

⛳️ Requirements

• Practical understanding of billed, allowed, and paid amounts.

• Experience with fee schedules and rate methodologies, including percent-of-Medicare, per diem, case rate, DRG, and percent-of-charge.

• Domain expertise at a health plan, TPA, repricing or payment-integrity vendor, reference-based pricing administrator, provider revenue-cycle organization, or network contracting organization.

• Familiarity with 837, 835, and eligibility file exchanges.

• Proficiency in writing effective integration requirements.

• Comfort in representing Nomi directly to brokers, TPA executives, or health systems.

• Self-motivated ability to establish priorities without a predefined roadmap.

• Ability to interpret a data model and write SQL.

• Capacity to provide clear guidance to engineers; production coding is not a prerequisite.

• Strong written communication skills.

• Preferred: experience in self-funded employer health, including TPA administration, direct contracting, reference-based pricing, or captives.

• Preferred: experience with platform migration or vendor claims-system implementation.

• Preferred: background as a founder or early operator, or experience utilizing automation and AI to replace manual operational tasks.

🏝️ Benefits

• Comprehensive healthcare coverage.

• Competitive salary with performance bonuses.

• Opportunities for professional development and growth.

• Flexible work environment with remote options.

• Collaborative and innovative company culture.