Product Manager - Healthcare Payer Domain (SME)

Product Manager

The successful candidate will play a pivotal role in driving business requirements, solution design, and collaboration across stakeholders to ensure delivery of impactful projects that meet healthcare payer business needs and compliance standards.

Responsibilities

• Act as a Subject Matter Expert for Healthcare Payer processes, operations, and regulations
• Define detailed business requirements, use cases, and functional specifications by engaging with stakeholders across payers, providers, and other healthcare entities
• Develop process flows and gap analysis to identify opportunities for system enhancements and operational efficiencies
• Collaborate effectively with IT, QA, and business units to ensure project deliverables meet scope and specifications
• Facilitate workshops and stakeholder meetings to gather insights and validate requirements
• Provide clear and concise documentation that translates complex healthcare payer processes for technical teams
• Lead testing strategy activities by creating test cases and participating in user acceptance testing (UAT)
• Stay informed of healthcare regulatory updates and payer industry trends, including CMS guidelines and emerging technologies
• Offer SME insights during system implementation to verify compliance and business alignment
• Support training initiatives and change management efforts to drive solution adoption

Requirements

• Bachelor’s degree in Computer Science, or related field, with preference for Master’s degree
• 10-16 years of experience in the Healthcare Payer domain as a Business Analyst or Product Manager
• Expertise in healthcare payer operations including claims processing, member management, provider networks, and benefit plans
• Knowledge of regulatory compliance standards such as CMS guidelines, ACA, and HIPAA requirements
• Background in payer systems encompassing enrolment, billing, claims management, and provider portals
• Showcase of strong analytical, problem-solving, and documentation capabilities
• Competency in stakeholder communication and management skills
• Familiarity with Agile/Scrum methodologies
• Proficiency in Business Analysis tools and techniques

Nice to have

• Certified Business Analysis Professional (CBAP) or equivalent
• Showcase of healthcare-specific certifications such as CHC or CPCO
• Understanding of payer-specific IT systems and software solutions