Senior Product Manager

The individual will be positioned directly alongside the platform team behind a large-scale Claims Adjudication Platform used by health plans to process and pay claims. The platform is in the middle of a multi-year modernization journey, and this role will help shape and drive that roadmap from the
product side, working day-to-day with the platform's product owners, engineering leads, and health plan stakeholders. This is a hands-on, embedded product role.
Key Responsibilities:
●Partner with the Claims Adjudication Platform's product, architecture, and engineering leads to define, sequence, and prioritize the modernization roadmap.
●Own and groom the product backlog for claims processing modules, writing clear epics, user stories, and acceptance criteria.
●Serve as the claims domain subject matter expert across the team, covering eligibility, benefits configuration, adjudication, pricing, payment, coordination of benefits (COB), subrogation, and appeals/grievances.
●Translate legacy platform business rules and edit logic into modernized, testable requirements without losing regulatory or contractual intent.
●Work directly with EDI transaction flows relevant to claims (837, 835, 276/277, 278) and ensure new capabilities stay compliant with HIPAA transaction standards.
●Facilitate backlog refinement, sprint planning, and other agile ceremonies; keep the team unblocked and focused on the highest-value work.
●Act as the primary point of contact between Simplify Alpha and the platform's leadership team on scope, tradeoffs, and delivery status.
●Define and validate user acceptance testing (UAT) criteria for claims outcomes before release.
●Identify risks and dependencies early, especially where modernization work touches downstream health plan operations.
Required Skills:
●8-12+ years of experience as a Product Owner, Product Manager, or senior Business Analyst in health plan/ payer claims environments.
●Deep, practical understanding of the claims lifecycle: intake, eligibility and benefits, adjudication, pricing, payment integrity, and appeals.
●Working knowledge of core healthcare EDI transactions (837, 835, 276/277, 278) and HIPAA transaction requirements.
●Experience writing detailed user stories and acceptance criteria for complex, rules-heavy systems.
●Comfort working directly with client stakeholders, including client-side product and engineering leadership.
●Solid agile/Scrum fundamentals, including backlog management tools such as JIRA and Confluence.
●Strong written and verbal communication skills; able to translate between business rules, technical
constraints, and regulatory requirements.

Work arrangement
Yes