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Responsibilities:
Own the end-to-end product roadmap for payer exchange, including eClaims submission, pre-auth workflows, remittance advice parsing, and denial management.
Work with national health authority counterparts to map regulatory claim formats and integration requirements into product specifications.
Translate payer business rules, ICD-10 coding constraints, and DRG logic into engineering-ready acceptance criteria.
Define and track product KPIs across claim acceptance rates, adjudication cycle times, denial reversal rates, and payer onboarding velocity.
Collaborate with the EMR team to close the clinical documentation to billing loop, ensuring charge capture is FHIR-native.
Build and maintain a payer integration matrix documenting connectivity status, format versions, and SLA commitments per payer.
Drive go-to-market for new payer corridors, working with BD and implementation teams to scope, price, and launch.
Participate in pre-sales and solutioning conversations with payer and provider clients
Requirements:
4-8 years of product experience with at least 2 years specifically in RCM, medical billing, payer operations, or health insurance technology.
Fluency in claims lifecycle: charge capture, claim generation, clearinghouse submission, adjudication, remittance, posting, and denial management.
Working knowledge of payer formats: FHIR ClaimResponse, HL7 837/835 DRG constructs, and pre-auth request and response schemas.
Be comfortable reading and writing detailed functional specifications and structured PRDs, not just user stories.
Ability to navigate ambiguity in B2B healthcare markets where requirements change with policy, not product cycles.
Strong analytical mindset: you track claim metrics, build dashboards, and use data to prioritise rather than opinions.
Experience working with engineering teams in Java/NestJS/TypeScript or equivalent backend environments.
Great to Have:
Experience with health insurance or social health markets.
Familiarity with GCC health insurance regulatory frameworks such as DHA, DOH, CCHI, or NPHIES.
Prior work in a B2B SaaS company or digital health product role.
Understanding of value-based care contracting versus fee-for-service and how each changes the claims data model.
Experience
4-8 yrs
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