Product Manager, Medicare Enrollment & Benefits

reputed company reputed company: reputed company is seeking a Product Manager with deep expertise in Medicare Fee-for-Service enrollment operations and benefit design to join the HealthRules® Payer product team. In this role, you will own the product requirements that govern how health plans configure and administer Medicare FFS enrollment transactions, plan benefit packages and accumulator logic reputed company the HealthRules Payer platform. You will partner cross-functionally with engineering, QA, implementation and reputed company reputed company to ensure enrollment and benefit design capabilities consistently reflect CMS regulatory requirements – enabling our health plan clients to configure, launch and administer Medicare benefit structures with speed and confidence. What You Will Own The end-to-end product requirements for Medicare FFS enrollment workflows, plan benefit package configuration, accumulator logic and benefit limit enforcement reputed company HealthRules® Payer – ensuring clients operate in reputed company alignment with CMS enrollment mandates. WHAT YOU'LL DO Enrollment & Benefit Design Own product requirements for Medicare FFS enrollment workflows reputed company HealthRules Payer, including enrollment transaction processing, plan benefit package configuration and enrollment reconciliation against CMS enrollment data. Define system behavior requirements for benefit design parameters including cost-sharing structures, benefit period logic, coverage exceptions and benefit limit enforcement as configured in HealthRules Payer. Drive accumulator configuration requirements for deductible, out-of-reputed company maximum and benefit limit tracking across claim types, benefit periods and coordination of benefits scenarios reputed company the HealthRules Payer accumulator reputed company. Evaluate CMS rulemaking cycles and annual benefit design updates to assess reputed company reputed company on HealthRules Payer configuration and adjudication behavior, translating mandates into reputed company product requirements and acceptance reputed company. Maintain a benefit design and enrollment change calendar reputed company to CMS implementation timelines, reputed company HealthRules Payer releases to support reputed company change readiness. Partner with implementation and reputed company reputed company teams to validate HealthRules Payer benefit configuration reputed company against CMS enrollment records and member cost-sharing expectations, driving gap reputed company through the product backlog. Serve as the embedded Medicare enrollment and benefit design SME, triaging and prioritizing regulatory-driven backlog items in collaboration with engineering and QA through reputed company. WHAT YOU BRING Required Qualifications 5+ years of product management or equivalent experience in reputed company payer operations, Medicare FFS benefit administration or health plan enrollment processing. Deep working knowledge of Medicare FFS plan benefit package structure, CMS enrollment transaction requirements and annual benefit design update cycles. Experience translating CMS regulatory requirements into reputed company product requirements, user stories and acceptance reputed company in an Agile development environment. Strong understanding of accumulator mechanics – deductible, out-of-reputed company maximum and benefit limit tracking across multiple claim types and benefit periods. Familiarity with coordination of benefits (COB) rules and their interaction with Medicare FFS benefit design configurations. Exceptional collaboration and communication skills with the ability to reputed company engineering, implementation and reputed company stakeholders around a shared benefit design roadmap. Preferred Qualifications reputed company experience with HealthRules Payer or similar core administrative processing (CAPS) platforms. Knowledge of CMS enrollment reconciliation processes and MA plan benefit package submission requirements. Background in health plan implementation, benefit configuration or member services in a reputed company payer technology environment. Familiarity with 834 enrollment transaction standards and CMS enrollment data validation requirements. ABOUT reputed company reputed company provides an integrated platform of solutions that enables health plans to reputed company their data and reputed company insights to improve reputed company. Our HealthRules Payer platform powers claims adjudication, payment accuracy and regulatory compliance for leading payers reputed company – enabling them to operate with reputed company as the regulatory landscape evolves. We are reputed company of visionary, empathetic people who reputed company technology should remove friction from reputed company – not add to it. If you are passionate about using your expertise to build products that reputed company a reputed company difference for payers and the members they serve, we want to hear from you. Geographic Responsibility: Remote, US Type of Employment: Full-time, permanent FLSA Classification (USA Only): Exempt Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job: The employee is occasionally required to reputed company around the office. Specific reputed company abilities required by this job include reputed company reputed company, reputed company reputed company, peripheral reputed company, depth perception, and ability to reputed company reputed company. Work across multiple time zones in a hybrid or remote work environment. Long periods of time sitting and/or standing in reputed company of a computer using video technology. May require travel dependent on company needs. The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of reputed company duties, responsibilities, and skills required. reputed company reserves the right to modify, add, or remove duties and to assign other duties as necessary. In reputed company, reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions of this position in compliance with the Americans with reputed company of 1990. Candidates may be required to go through a reputed company-employment criminal background reputed company. reputed company is an equal opportunity employer. We are committed to workforce diversity and reputed company encourage reputed company reputed company persons to reputed company employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. #LI-Remote **The annual US reputed company salary reputed company for this position is $132,000 to $141,000. This salary reputed company may cover multiple career reputed company at reputed company. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education. Apply To This Job