Senior Healthcare Payer Product Owner Business Analyst
Role Summary
Seeking a senior healthcare professional with strong Healthcare Payer, Claims, Business Analysis, and Product Owner experience. The ideal candidate will drive requirements, build stakeholder consensus, translate business needs into detailed solutions, and support prototypesPOCs and innovative technology solutions.
Key Responsibilities
Lead requirements gathering, stakeholder alignment, prioritization, and consensus across business and IT teams.
Translate high-level business requirements into detailed user stories, use cases, functional requirements, acceptance criteria, and product backlog items.
Manage product backlogs and support program increments, sprint planning, acceptance testing, and solution validation.
Collaborate with Data Scientists, AI Architects, and technical teams to develop rapid solutions, prototypes, and POCs.
Develop business POVs, use cases, articles, and solution concepts based on healthcare industry trends and regulatory changes.
Identify opportunities to apply AI and Generative AI to healthcare payer business problems.
Support account and client teams with innovative technology solutions aligned to business needs and AI maturity.
Drive teams toward demonstrable, showcase-ready solutions while influencing stakeholders and resolving requirements conflicts.
Stay current with healthcare interoperability standards including FHIR, HL7, and EDI, as well as value-based care and cost-of-care initiatives.
Identify innovative solution concepts and potential opportunities for patents, copyrights, and trademarks.
Required Qualifications
6 8+ years of relevant Business Analysis Product Owner experience.
10+ years of hands-on Healthcare Payer experience preferred.
Strong knowledge of healthcare claims, claims engines, claims processing, products, and benefits.
Experience across payer functions such as Membership, Providers, Prior Authorization, Utilization Management, Claims, Program Integrity, Sales & Marketing, and Healthcare Product Management.
Strong understanding of Medicare, Medicaid, CMS guidelines, and healthcare industry trends.
Proven Product Owner experience managing product backlogs, user stories, use cases, acceptance criteria, and sprintprogram increment planning.
Strong requirements engineering and analytical skills with the ability to develop SMART requirements.
Excellent communication, influencing, stakeholder management, and team leadership skills.
Ability to independently understand complex business requirements and develop practical solutions or POCs.
Preferred Desirable Skills
Healthcare Payer
Healthcare Claims
Healthcare Domain
Healthcare Principles and Functions
Healthcare Pharmacy PBM
Product Ownership
Business Analysis
FHIR HL7 EDI
AI Generative AI
Healthcare Interoperability
Medicare Medicaid CMS
Value-Based Care
Claims Processing & Claims Engines
Key Skills
Healthcare Payer Healthcare Claims Product Owner Business Analysis Healthcare Domain Claims Processing Medicare Medicaid CMS FHIR HL7 EDI AI Generative AI Product Backlog User Stories Requirements Management
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