Product Development Coordinator/Manager

Hiring a Product Development Manager with experience in the Health Plan, PBM, or Medicare Advantage space; experience coordinating offshore development teams; strong Agile/Scrum and SDLC knowledge

100% remote in US only 

What You’ll Do
1) Product Strategy & Roadmap

• Own the product strategy for claims intake, validation, adjudication, pricing, payment, remittance, audit, and related integrations (EHR, Enrollment, UM, Risk, Quality/NCQA, Coding Scrubber).
• Define and maintain a quarterly roadmap aligned to business OKRs, regulatory timelines, and client commitments; socialize priorities with Ops, Compliance, Finance, and Technology.

2) Business–IT Translation

• Convert operational goals and regulatory constraints into epics, features, and user stories with clear acceptance criteria, edge cases, and non-functional requirements (auditability, throughput, privacy/security).
• Lead backlog grooming and sprint planning with offshore/onshore engineering; ensure requirements are unambiguous and testable.

3) Claims Domain Ownership

• Serve as the product SME across the claims lifecycle; design claim edits and reference data strategies (NCCI, OCE, medicare pricing rules, COB/TPL, provider/plan configuration).
• Specify and validate EDI/X12 transactions: 837 (P/I/D), 835, 270/271, 276/277, 278; coordinate with clearinghouses and trading partners.
• Support standards and interoperability (HL7/FHIR, NCPDP for pharmacy).

4) Delivery & Quality

• Drive UAT with Claims Ops; establish and monitor release gates for compliance, performance, and data quality (PHI handling, audit logs, error rates).
• Partner with QA to design scenario-based test suites and data validation for adjudication rules, pricing, and remittance advice.

5) Regulatory & Compliance

• Ensure end-to-end adherence to HIPAA/HITECH, CMS guidance (including Medicare Advantage considerations), ERISA/state requirements, and internal security controls (RBAC, audit trails).

6) Data & Analytics

• Define product metrics and dashboards (Power BI/Tableau) for auto adjudication rate, first pass yield, claim touch rate, cycle time, payment accuracy, denial/appeal patterns, and operational throughput.
• Collaborate with Data Engineering on pipelines, reconciliations, and exception management; drive root?cause analysis for defects and leakage.

7) Stakeholder & Vendor Coordination

• Act as the day-to-day product point for Claims, Operations, Compliance, Client Services, and external vendors/clearinghouses; manage SLAs and integration timelines.
• Facilitate time zoneaware ceremonies with the offshore dev team (4 FTEs) and coordinate closely with the onshore PM and developer.

8) Continuous Improvement

• Lead discovery to simplify workflows and increase automation; champion process and UX enhancements for adjusters, billing teams, and provider/client interfaces.
• Maintain a living configuration playbook (plan/benefit setup, pricing rules, enrollment tie-ins) to reduce errors and speed onboarding.

Minimum Qualifications

• 5–7+ years in product management or solutions leadership in healthcare payer/TPA/MSO environments with direct ownership of claims platforms.
• Practical experience with EDI/X12 (837/835/270/271/276/277/278), claim adjudication rules, benefit configuration, and clearinghouse integrations.
• Proven ability to translate business/regulatory requirements into product specs and collaborate with engineering to ship iterative releases.
• Strong grounding in HIPAA, data privacy/security, and audit/compliance practices.

Preferred Skills

• Exposure to Medicare Advantage operations and CMS timelines; familiarity with NCQA quality programs and utilization management touchpoints.
• Technical fluency with one or more of: Azure, .NET/C#, Python, SQL; tooling like Azure DevOps/Jira/Confluence, Power BI/Tableau.
• Working knowledge of ICD 10, CPT/HCPCS, DRG/APC, provider contracting/pricing, COB/TPL, prior authorization workflows.
• Experience collaborating with offshore engineering teams, managing cross time zone delivery.

Determining compensation for this role (and others) at Vaco/Highspring depends upon a wide array of factors including but not limited to the individual’s skill sets, experience and training, licensure and certifications, office location and other geographic considerations, as well as other business and organizational needs. With that said, as required by local law in geographies that require salary range disclosure, Vaco/Highspring notes the salary range for the role is noted in this job posting. The individual may also be eligible for discretionary bonuses, and can participate in medical, dental, and vision benefits as well as the company’s 401(k) retirement plan. Additional disclaimer: Unless otherwise noted in the job description, the position Vaco/Highspring is filing for is occupied. Please note, however, that Vaco/Highspring is regularly asked to provide talent to other organizations. By submitting to this position, you are agreeing to be included in our talent pool for future hiring for similarly qualified positions. Submissions to this position are subject to the use of AI to perform preliminary candidate screenings, focused on ensuring minimum job requirements noted in the position are satisfied. Further assessment of candidates beyond this initial phase within Vaco/Highspring will be otherwise assessed by recruiters and hiring managers. Vaco/Highspring does not have knowledge of the tools used by its clients in making final hiring decisions and cannot opine on their use of AI products.