Product Manager, Medicare Enrollment – Benefits

🕒 6 days ago

🇺🇸 United States – Remote

💵 $132k - $141k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

✅ Product Manager

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

Healthcare Insurance • SaaS • Fintech

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Own product requirements for Medicare FFS enrollment workflows within HealthRules Payer, including enrollment transaction processing, plan benefit package configuration and enrollment reconciliation against CMS enrollment data. • Define system behavior requirements for benefit design parameters including cost-sharing structures, benefit period logic, coverage exceptions and benefit limit enforcement as configured in HealthRules Payer. • Drive accumulator configuration requirements for deductible, out-of-pocket maximum and benefit limit tracking across claim types, benefit periods and coordination of benefits scenarios within the HealthRules Payer accumulator framework. • Evaluate CMS rulemaking cycles and annual benefit design updates to assess downstream impact on HealthRules Payer configuration and adjudication behavior, translating mandates into structured product requirements and acceptance criteria. • Maintain a benefit design and enrollment change calendar aligned to CMS implementation timelines, sequencing HealthRules Payer releases to support client change readiness. • Partner with implementation and client success teams to validate HealthRules Payer benefit configuration output against CMS enrollment records and member cost-sharing expectations, driving gap resolution through the product backlog. • Serve as the embedded Medicare enrollment and benefit design SME, triaging and prioritizing regulatory-driven backlog items in collaboration with engineering and QA through resolution.

🎯 Requirements

• 5+ years of product management or equivalent experience in healthcare payer operations, Medicare FFS benefit administration or health plan enrollment processing. • Deep working knowledge of Medicare FFS plan benefit package structure, CMS enrollment transaction requirements and annual benefit design update cycles. • Experience translating CMS regulatory requirements into structured product requirements, user stories and acceptance criteria in an Agile development environment. • Strong understanding of accumulator mechanics – deductible, out-of-pocket maximum and benefit limit tracking across multiple claim types and benefit periods. • Familiarity with coordination of benefits (COB) rules and their interaction with Medicare FFS benefit design configurations. • Exceptional collaboration and communication skills with the ability to align engineering, implementation and client stakeholders around a shared benefit design roadmap.

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development opportunities