Company :

Highmark Health

Job Description :

JOB SUMMARY

The Senior Product Manager, Claims will define the product strategy, vision, and value proposition of Highmark’s claims’ platforms for our customers - employers & members. This includes defining an experience strategy for a modern claims intake and processing platform, simplifying explanation of benefits for members, improving payment integrity, and optimizing the experience of denials, appeals, and grievances. The ideal candidate outlines the strategic vision and business case, gains alignment and support from key strategic partners and stakeholders, and oversees execution of that vision, while also providing coaching and guidance to junior team members. This incumbent will attend and participate in milestone reviews with the Delivery team.

A d eep understanding of the health insurance claims process will be essential . This includes a strong grasp of claims intake, adjudication, payment, appeals, denials, and grievances along with familiarity with various claim types (medical, dental, pharmacy, etc.). Demonstrated success with leading claims transformations as well as experience with claims systems and technology will be essential. This includes k nowledge of claims processing platforms, data management systems, and relevant technologies like AI/ML to optimize claims processing.

ESSENTIAL RESPONSIBILITIES

• Understand the department's and the company's strategic roadmap and competitive position, and develop a holistic product vision and the corresponding product strategy to drive maximum value.

• Actively anticipate future needs and utilize metrics and qualitative input to identify asset improvement opportunities.

• Represent the product in all governance meetings.

• Clearly set and communicate roadmaps, priorities, experiments, and decisions across audiences, from product team to executive levels.

• Serve as accountable owner for the sets of products/tools within the designated portfolio

• Identify and drive both cross-product and cross-customer value and shared learnings.

• Guide Agile developments in the role of Product Owner.

• Own the product backlog and use input from internal and partner teams to frequently refresh and re-prioritize the backlog.

• Provide coaching and guidance to team members on product vision and strategic road mapping.

• Other duties as assigned or requested.

ADDITIONAL RESPONSIBILITIES

• Develop a clear vision and translate it into a strategy and actionable roadmap.

EXPERIENCE

Required

• 5 years of Product experience

To include:

• 5 years with the Software Lifecycle

• 3 years of Advanced domain experience

Preferred

• 3 years with agile process

• Experience with AI-enabled transformation

• Knowledge of regulatory requirements related to claims processing

• Strong understanding of customer experience principles and best practices

SKILLS

• Business Acumen for P&Ls

• Communication

• Conflict Management

EDUCATION

Required

• ​Bachelor’s degree in science, technology, mathematics or related field OR relevant experience and/or education as determined by the company in lieu of bachelor's degree.

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other than English) :

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Occasionally

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Never

Lifting: 25 to 50 pounds

Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies .

_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. _

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J250901