Health Product Manager, Claims

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XO Health Inc.

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

XO Health Inc. is a company that provides comprehensive, tech-enabled health benefit solutions specifically designed for the self-insured market. Their services cater to self-insured employers, brokers and consultants, and third-party administrators, aiming to unify the healthcare experience. XO Health offers a value-based provider network, member advocacy and care navigation, integrated medical and pharmacy plans, and employer stop-loss coverage. Their solutions are focused on balancing cost and quality, providing flexible and tailored healthcare solutions for employers.

📋 Description

• Define and own the product vision and strategy for XO Health's claims processing platform, in partnership with Engineering, Claims Operations, and executive stakeholders. • Build and maintain the product roadmap for the claims platform, planning out the right order to build adjudication logic, while integrating pricing, EDI transactions, and payment features. • Set timeline goals and milestones for the claims build, balancing business urgency, technical feasibility, and dependencies across teams. • Translate long-term strategy into sprint-level priorities, and communicate tradeoffs clearly to leadership when scope, timeline, or resourcing conflicts arise. • Serve as the primary liaison between business stakeholders and the technical/engineering team throughout the claims build. • Draft detailed, clear business requirements and user stories for claims adjudication, pricing, EDI transaction handling (837, 835, 834), and claim adjustment workflows. • Translate complex claims processing rules (CARC/RARC and group codes, duplicate detection, accumulator management, medical necessity edits, correct-coding logic, workflow design, and business rules) into requirements engineers can build against. • Partner with engineering on solution design, review technical approaches for feasibility, and flag business risk or compliance concerns early. • Own acceptance criteria and participate in user acceptance testing (UAT) to confirm that delivered functionality meets business intent before release. • Conduct discovery with cross-functional teams to surface pain points, edge cases, and process gaps in current claims handling. • Identify, manage, and mitigate risks/dependencies to ensure a successful release. • Own and groom the product backlog, prioritizing features and fixes based on business impact, regulatory requirements, and platform dependencies. • Define and track success metrics for the claims platform build, including accuracy, turnaround time, auto-adjudication rate, and denial/appeal volume. • Collaborate with Claims Operations, EDI, Network, Compliance, Legal, and Client-facing teams to ensure the claims platform reflects real operational and contractual needs. • Partner with vendor management and clearinghouse/EDI partners on transaction standards, connectivity, and migration workstreams. • Coordinate with Data, Analytics, and Reporting teams to ensure the claims platform supports downstream reporting, audit, and regulatory needs. • Communicate roadmap status, risks, and decisions clearly to stakeholders and leadership across the organization. • Plan and support release management, including phased rollouts, provider/client communication, and training materials for internal teams. • Monitor platform performance and user feedback post-launch, and maintain a continuous improvement backlog. • Identify recurring issues, platform gaps, or process inefficiencies and drive resolution with the technical team. • Document product decisions, business requirements, and process changes to support institutional knowledge and audit needs.

🎯 Requirements

• Experience in US healthcare, health insurance, claims operations, or employee benefits with working knowledge of the claims lifecycle, adjudication, and payment processes. • 5+ years of product management experience, including experience owning a product roadmap and strategy from discovery through launch. • Demonstrated ability to draft clear, detailed business requirements and user stories, and to serve as a liaison between business stakeholders and technical teams. • Strong analytical and problem-solving skills, with the ability to translate complex operational rules into structured product requirements. • Experience managing a product backlog and roadmap, setting priorities, and communicating timeline tradeoffs to stakeholders and leadership. • Excellent written and verbal communication skills, with the ability to work cross-functionally across business, operations, and engineering teams. • Comfort operating in an ambiguous, fast-paced environment where the tools and processes are still being built.

🏖️ Benefits

• Full compensation packages based on candidate experience and relevant certifications.