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HealthEdge is on a mission to drive a digital revolution in healthcare.
The Role
Owns and manages the product backlog for a healthcare claims administration platform. Translates stakeholder and healthcare requirements into epics, user stories, acceptance criteria, workflows, and functional documentation. Coordinates Agile ceremonies, collaborates with engineering, UX, QA, and stakeholders, and supports feature delivery. Applies knowledge of claims, billing, reimbursement, payer operations, healthcare regulations, and AI-enabled product management tools.
Summary Generated by Built In
Overview
Overview
Product Owner
BASIC SUMMARY:
We are seeking a detail-oriented and execution-focused Product Owner to support the delivery of features and enhancements within our healthcare claims administration platform. This role is responsible for translating business and stakeholder needs into clear, actionable user stories and working closely with engineering teams to ensure timely, high-quality delivery. The ideal candidate brings healthcare domain knowledge, understands Agile processes, and is comfortable using AI-enabled tools to support requirements definition and backlog management.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Backlog Ownership & Agile Execution
- Own and manage the product backlog, ensuring stories are well-defined, prioritized, and aligned with sprint goals
- Write epics, user stories, and acceptance criteria that are clear, testable, and customer-centric
- Conduct regular backlog grooming and sprint planning in collaboration with the Scrum team
- Manage daily standups, sprint reviews, and retrospectives as an active team member
- Ensure user stories meet the definition of ready and done before development and release
Requirements Gathering & User Story Development
- Collaborate with stakeholders, subject matter experts, and internal teams to gather and refine product requirements
- Use AI tools (where applicable) to support the creation of epics, themes, and user stories
- Conduct gap analysis and validation of requirements to ensure completeness and feasibility
- Support refinement of use cases, workflows, and functional documentation
Cross-Functional Collaboration
- Serve as the primary point of contact for development teams during sprint execution
- Partner with UX/UI designers to ensure user stories are aligned with design principles and usability goals
- Support QA teams by clarifying acceptance criteria and reviewing test cases as needed
- Coordinate with other Product Owners to manage interdependencies between features
Customer & Stakeholder Engagement
- Participate in stakeholder meetings to capture feature requests, enhancement ideas, and feedback
- Communicate updates to internal stakeholders on backlog priorities, delivery timelines, and sprint progress
- Help ensure features delivered meet customer needs and stakeholder expectations
Healthcare Domain Support
- Apply working knowledge of healthcare claims workflows, billing terminology, and reimbursement processes
- Support compliance with healthcare regulations (HIPAA, HITECH) in collaboration with internal teams
- Assist in translating complex healthcare requirements into understandable product features
MINIMUM REQUIRED QUALIFICATIONS
- Bachelor’s degree in Business, Healthcare Administration, Computer Science, or a related field
- 2+ years of product management experience; healthcare technology or claims administration preferred
- 2+ years of experience working with AI tools for product development, requirements engineering, or business analysis preferred
- Familiarity with Agile software development and Scrum methodology
- Proficiency with Jira (or similar Agile tools) for backlog management
- AI-Enabled Product Management
- Demonstrated experience incorporating AI tools into day-to-day product management activities
- Ability to establish and maintain reusable prompts, instructions, and workflows that improve requirements quality and team productivity
- Ability to validate, challenge, and refine AI-generated artifacts to ensure business, technical, regulatory, and operational accuracy
- Basic understanding of software development processes and technical constraints
- Familiarity with collaboration tools (e.g., Confluence, Miro, Figma)
- Strong written and verbal communication skills for conveying requirements and feedback
- High attention to detail and organizational skills
- Ability to manage competing priorities and meet deadlines in a fast-paced environment
- Comfortable working with cross-functional teams and resolving blockers quickly
- Experience working in healthcare technology, payer operations, care management, utilization management, claims administration, or related healthcare domain
Preferred Qualifications
- Certified Scrum Product Owner (CSPO) or similar Agile certification
- Understanding of healthcare data standards (e.g., HL7, FHIR, X12 EDI)
- Experience with Utilization Management, Prior Authorization, Care Management, Clinical Review, or related payer operations workflows
- Familiarity with medical necessity determination processes
- Familiarity with InterQual, MCG, or payer-specific clinical guidelines
- Understanding of healthcare regulatory requirements including CMS, NCQA, URAC, HIPAA, and state-specific UM regulations
- Experience collaborating with UM nurses, Medical Directors, physician reviewers, and clinical operations teams
- Knowledge of Commercial, Medicare Advantage, Medicaid, and Dual Eligible healthcare programs
- Familiarity with authorization intake, clinical review, peer review, and determination workflows
- Experience with workflow engines, rules engines, or clinical decision support systems
Skills Required
- Bachelor's degree in Business, Healthcare Administration, Computer Science, or a related field
- At least 2 years of product management experience
- At least 2 years of experience working with AI tools for product development, requirements engineering, or business analysis
- Familiarity with Agile software development and Scrum methodology
- Proficiency with Jira or similar Agile backlog management tools
- Experience incorporating AI tools into day-to-day product management activities
- Ability to create reusable prompts, instructions, and workflows for requirements quality and team productivity
- Ability to validate and refine AI-generated artifacts for business, technical, regulatory, and operational accuracy
- Basic understanding of software development processes and technical constraints
- Familiarity with collaboration tools such as Confluence, Miro, and Figma
- Strong written and verbal communication skills
- High attention to detail and organizational skills
- Ability to manage competing priorities and meet deadlines in a fast-paced environment
- Comfort working with cross-functional teams and resolving blockers quickly
- Experience in healthcare technology, payer operations, care management, utilization management, claims administration, or a related healthcare domain
- Certified Scrum Product Owner certification or similar Agile certification
- Understanding of healthcare data standards such as HL7, FHIR, or X12 EDI
- Experience with utilization management, prior authorization, care management, clinical review, or related payer workflows
- Familiarity with medical necessity determination processes and clinical guidelines such as InterQual or MCG
- Understanding of CMS, NCQA, URAC, HIPAA, and state-specific utilization management regulations
- Experience collaborating with utilization management nurses, Medical Directors, physician reviewers, and clinical operations teams
- Knowledge of Commercial, Medicare Advantage, Medicaid, and Dual Eligible healthcare programs
- Familiarity with authorization intake, clinical review, peer review, and determination workflows
- Experience with workflow engines, rules engines, or clinical decision support systems
HealthEdge Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about HealthEdge and has not been reviewed or approved by HealthEdge.
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Leave & Time Off Breadth — Time off is positioned as relatively generous, with a large holiday calendar, vacation to start, unlimited sick time, and volunteer days. The overall package also includes flexibility elements that can increase the practical value of time off depending on role.
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Retirement Support — Retirement support stands out through a 401(k) match with immediate vesting, which strengthens the near-term value of the benefit. HSA/FSA options and employer contributions are also highlighted as part of the financial benefits mix.
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Inclusive Benefits Coverage — Medical coverage is described as inclusive, explicitly including infertility treatments and gender-affirming care alongside EAP and mental-health services. This breadth can improve perceived total rewards for employees with varied healthcare needs.
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The Company
What We Do
HealthEdge is on a mission to drive a digital revolution in healthcare. We’re connecting health plans, providers, and patients with end-to-end digital technology solutions to support new business models, reduce administrative costs and improve health outcomes. Our growing portfolio of products (HealthRules Payor, Source, GuidingCare, and Wellframe) provides talented and passionate professionals with opportunities to lead change and make a lasting, global impact in healthcare. Driving our mission are 2,000+ professionals worldwide. Together, we are committed to innovating a world where healthcare can focus on people.
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