We are seeking an experienced Agile Product Owner with strong Healthcare Payer / Health Plan domain expertise to lead strategic Provider Transformation initiatives.
The ideal candidate will have deep knowledge of Claims Processing & Adjudication, Provider Data Management, Provider Enrollment, Credentialing, Provider Contracting, Provider Network Management, and Healthcare EDI transactions (834, 835, 837).
The Product Owner will own and prioritize the product backlog, translate business requirements into user stories and acceptance criteria, collaborate with business and technical stakeholders, and drive modernization of provider-facing systems and processes through Agile delivery.
Key Responsibilities
- Own, manage, and prioritize the product backlog for Provider Transformation initiatives.
- Translate business requirements into detailed user stories and acceptance criteria.
- Partner with business stakeholders, operations teams, architects, QA, and development teams to define product vision and roadmap.
- Drive modernization initiatives across:
- Provider Enrollment
- Provider Credentialing
- Provider Contracting
- Provider Data Management
- Provider Directory Management
- Provider Network Management
- Claims Processing & Adjudication
- Facilitate Agile ceremonies including sprint planning, backlog grooming/refinement, sprint reviews, and retrospectives.
- Collaborate with cross-functional teams to deliver scalable healthcare solutions.
- Support compliance with healthcare regulations, including CMS and HIPAA requirements.
- Analyze current-state workflows and identify opportunities for process optimization and automation.
- Support large-scale transformation, migration, modernization, and legacy platform replacement initiatives.
- Work closely with QA teams to validate requirements and support UAT activities.
Required Qualifications
- Bachelor''s degree in Business, Information Systems, Healthcare Administration, or a related field.
- 7+ years of Healthcare Payer / Health Plan domain experience.
- 3+ years of Product Owner, Product Manager, or Senior Business Analyst experience.
- Strong experience with:
- Claims Processing
- Claims Adjudication
- Provider Data Management
- Provider Enrollment & Credentialing
- Provider Contracting
- Provider Network Operations
- Hands-on experience with Healthcare EDI transactions:
- X12 834 – Enrollment
- X12 835 – Remittance Advice
- X12 837 – Claims
- Experience creating and managing:
- Product Backlogs
- User Stories
- Acceptance Criteria
- Release Planning
- UAT
- Strong knowledge of Agile/Scrum methodologies.
- Experience with Jira, Azure DevOps, Rally, or similar Agile tools.
- Excellent stakeholder management and communication skills.
Preferred Qualifications
- CSPO or SAFe Product Owner/Product Manager certification.
- Experience with Medicare, Medicaid, and Commercial Health Plans.
- Knowledge of CMS provider directory regulations and compliance requirements.
- Experience with Provider Transformation, system modernization, legacy platform replacement, migration, or business process re-engineering.
- Exposure to healthcare data integration and interoperability initiatives.
Required Skills
Healthcare Domain:
Healthcare Payer, Health Plan, Claims Adjudication, Claims Processing, Provider Data Management, Provider Enrollment, Credentialing, Provider Contracting, Provider Network Management, Medicare, Medicaid, Commercial Health Plans, CMS, HIPAA
Technical / Functional:
EDI 834, EDI 835, EDI 837, X12, HIPAA Transactions, Product Backlog Management, User Stories, Acceptance Criteria, UAT, Business Analysis, Process Re-engineering
Agile Tools:
Jira, Azure DevOps, Rally, Confluence
Ideal Candidate
The ideal candidate will have extensive Healthcare Payer / Health Plan experience with strong expertise in Claims Adjudication, Provider Operations, Provider Data Management, and EDI transactions, combined with proven Agile Product Ownership experience managing product roadmaps, stakeholder expectations, backlogs, and enterprise transformation programs.
IMPORTANT – W2 ONLY
This is a W2 Contract position.
We can consider: , GC-EAD, -EAD, L2-EAD, TN
We cannot consider: H1B, H1B Transfer, OPT, or CPT candidates.
Qualified candidates are encouraged to apply with an updated resume and contact information.
Recruiter Contact: Sasank | Sr. Talent Acquisition Specialist
LinkedIn:
Qualified candidates can connect with me on LinkedIn and mention “Agile Product Owner – Healthcare Provider Transformation” when reaching out.
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