Health Product Manager, Claims

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

📋 Description

• Define and lead the product vision and strategy for XO Health's claims processing platform, collaborating with Engineering, Claims Operations, and executive stakeholders.

• Develop and sustain the product roadmap for the claims platform, strategically planning the order of building adjudication logic while incorporating pricing, EDI transactions, and payment functionalities.

• Establish timeline goals and milestones for the claims build, balancing business urgency, technical feasibility, and team dependencies.

• Convert long-term strategy into sprint-level priorities, effectively communicating trade-offs to leadership in instances of scope, timeline, or resource conflicts.

• Act as the main point of contact between business stakeholders and the technical/engineering team throughout the claims development process.

• Create detailed, clear business requirements and user stories for claims adjudication, pricing, EDI transaction processing (837, 835, 834), and claim adjustment workflows.

• Transform complex claims processing rules (CARC/RARC and group codes, duplicate detection, accumulator management, medical necessity edits, correct-coding logic, workflow design, and business rules) into actionable requirements for engineers.

• Collaborate with engineering on solution design, evaluate technical approaches for feasibility, and promptly identify business risk or compliance issues.

• Own acceptance criteria and engage in user acceptance testing (UAT) to verify that delivered functionality aligns with business objectives prior to release.

• Conduct discovery sessions with cross-functional teams to identify pain points, edge cases, and process gaps in the current claims handling practices.

• Recognize, manage, and mitigate risks and dependencies to ensure a successful product release.

• Manage and refine the product backlog, prioritizing features and fixes according to business impact, regulatory mandates, and platform interdependencies.

• Define and monitor success metrics for the claims platform development, including accuracy, turnaround time, auto-adjudication rates, and denial/appeal volumes.

• Collaborate with Claims Operations, EDI, Network, Compliance, Legal, and Client-facing teams to ensure the claims platform meets operational and contractual requirements.

• Partner with vendor management and clearinghouse/EDI partners regarding transaction standards, connectivity, and migration initiatives.

• Work with Data, Analytics, and Reporting teams to ensure that the claims platform meets downstream reporting, audit, and regulatory requirements.

• Clearly communicate roadmap status, risks, and decisions to stakeholders and leadership throughout the organization.

• Plan and facilitate release management, including phased rollouts, provider/client communications, and training materials for internal teams.

• Monitor platform performance and user feedback after launch, maintaining a backlog for continuous improvement.

• Identify recurring issues, platform deficiencies, or process inefficiencies and drive resolutions with the technical team.

• Document product decisions, business requirements, and process changes to support institutional knowledge and audit compliance.

⛳️ Requirements

• Experience in US healthcare, health insurance, claims operations, or employee benefits with a solid understanding of the claims lifecycle, adjudication, and payment processes.

• Over 5 years of product management experience, including responsibility for a product roadmap and strategy from discovery to launch.

• Proven ability to draft clear, detailed business requirements and user stories, acting as a liaison between business stakeholders and technical teams.

• Strong analytical and problem-solving capabilities, with the ability to convert complex operational rules into structured product requirements.

• Proficient in managing a product backlog and roadmap, establishing priorities, and communicating timeline trade-offs to stakeholders and leadership.

• Exceptional written and verbal communication skills, capable of working cross-functionally among business, operations, and engineering teams.

• Comfortable navigating an ambiguous, fast-paced environment where tools and processes are still under development.

🏝️ Benefits

• Comprehensive compensation packages based on candidate experience and relevant certifications.