Senior Product Researcher Health Plan (payer) systems

1. Role Summary
We are seeking a Senior Product Researcher who is a subject matter expert (SME) in Health Plan (payer) systems, with deep functional knowledge across Member Enrollment, Claims Adjudication, and Payment Management. This person will research emerging market concepts and regulatory changes in the health plan space, translate client and stakeholder requirements into clear, well-structured product inputs, and guide the product team on how new capabilities should be prioritized and sequenced. The ideal candidate combines hands-on payer-domain expertise with strong research and analytical rigor.
2. Key Responsibilities
Serve as the internal subject matter expert (SME) on core Health Plan systems, including Member Enrollment, Claims Adjudication, and Payment/Provider Reimbursement Management.
Research emerging trends, technologies, and regulatory changes (CMS, HIPAA, ACA, state Medicaid mandates, etc.) impacting health plan operations and products.
Gather and analyze client and business stakeholder requirements; translate ambiguous requests into clearly structured, prioritized requirement documents.
Evaluate new product concepts and features for feasibility, compliance, and market fit before they enter the development pipeline.
Map end-to-end payer workflows to identify gaps, inefficiencies, and opportunities across enrollment, eligibility, adjudication, and payment cycles.
Partner with Product Managers, Business Analysts, and Engineering teams to sequence requirements into an actionable, correctly ordered backlog.
Conduct competitive and market research on health plan administration platforms, such as core administration systems, claims engines, and enrollment portals.
Present findings, recommendations, and requirement structures to senior stakeholders and leadership.
Mentor junior researchers and analysts on payer-domain concepts and research methodology.
Maintain a repository of domain knowledge, regulatory updates, and competitive intelligence specific to health plan systems.
3. Required Skills & Qualifications
5–8+ years of experience in product research, business analysis, or subject matter expert (SME) roles within the health plan/payer industry.
Demonstrated hands-on expertise in at least two of the following areas: Member Enrollment, Claims Adjudication, and Payment Management.
Strong understanding of healthcare regulatory frameworks, including HIPAA, ACA, CMS guidelines, and state Medicaid requirements.
Proven ability to convert complex client and business requirements into structured, prioritized documentation.
Experience with core health plan administration platforms.
Strong analytical and research skills, with the ability to synthesize market, regulatory, and client data into actionable insights.
Excellent stakeholder management, written communication, and presentation skills.
Bachelor’s degree in Healthcare Administration, Business, Information Systems, or a related field. A master’s degree is a plus.

Work arrangement
Hybrid