Claims System Product Manager

Vaya Health; North Carolina; Remote; USD 99,000 - 130,000; Full time

Job summary

An established industry player is seeking a Claims System Product Manager to lead a team in managing claims processing systems. This remote role offers the chance to shape the strategic direction of claims management software while collaborating with cross-functional teams. The ideal candidate will possess extensive experience in data systems management and a strong understanding of Medicaid regulations. With a focus on stakeholder engagement and project oversight, you will play a crucial role in ensuring the efficiency and effectiveness of claims processing. Join a forward-thinking organization that values innovation and teamwork.

Qualifications

• 7+ years of data systems management experience, especially in claims or health insurance.
• 5+ years in a supervisory/managerial role.

Responsibilities

• Oversee a team managing claims management systems and applications.
• Define and implement the strategic roadmap for claims software.

Skills

Leadership and team management

Excellent communication

Analytical and problem-solving

Claims management software proficiency

Vendor management

Education

Bachelor’s degree in Business Administration

Bachelor’s degree in Information Systems Management

Bachelor’s degree in Health Information Management

Tools

Data analysis tools

Project management applications

Job description

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Salary Range: $99,963.31 to $129,952.29 annually.

Location: Remote – This is a home-based, virtual position operating Monday – Friday from 8:30 am to 5:00 pm EST. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.

General Statement of Job

The Claims System Product Manager will provide strategic leadership and oversight to a team of Systems Analysts managing Vaya’s claims management system and supporting applications. Operating within the Information Services division and collaborating with cross-functional teams, the role involves defining and implementing the strategic roadmap for Vaya’s Claims Management software, ensuring alignment with organizational goals, mission, vision, and values.

Responsibilities include overseeing staff and vendors responsible for system configuration, development, implementation, maintenance, and support. The role requires extensive stakeholder interaction to address claims processing issues and resolve concerns.

Additional duties involve managing Business Requirement Documents (BRDs), vendor contracts, and service desk tickets, while adhering to organizational policies and contractual obligations. The candidate must be detail-oriented, provide regular status updates, and ensure timely resolution of issues. The role also involves working with cross-functional teams to address escalations promptly, ensuring software is used in accordance with policies, and being familiar with North Carolina Medicaid regulations.

Essential Job Functions

Administrative Supervision and Functions

• Supervise the Claims Systems Analyst Supervisor team, including hiring, evaluation, and mentoring.
• Monitor workload and staffing needs to maintain productivity.
• Facilitate the design, development, and operation of claims management systems.
• Provide daily status updates to upper management.
• Track and escalate BRDs, vendor contracts, and ticket statuses, maintaining detailed records.

Project Oversight/Guidance

• Oversee software application selection, implementation, and maintenance.
• Allocate resources for projects, ensuring priorities align with organizational goals.
• Complete project reports and documentation for leadership and stakeholders.
• Develop and communicate organizational vision and project direction.
• Coordinate with IT and infrastructure teams to ensure project alignment with architecture and business goals.
• Ensure timely resolution of issues related to BRDs, vendor contracts, and tickets.

Product Management and Business Support

• Define vision, roadmap, and growth opportunities for the claims management system.
• Prioritize product features and development requests.
• Manage vendor relationships and act as escalation point.
• Coordinate with ISD teams to prioritize projects and enhancements.
• Escalate vendor and ticket issues to ensure process efficiency.

Other duties as assigned

Knowledge, Skills, & Abilities

Knowledge

• Deep understanding of claims processing software systems and insurance principles, including Medicaid regulations (especially North Carolina).
• Knowledge of project management methodologies and business analysis tools.

Skills

• Leadership and team management skills.
• Excellent communication skills for engaging stakeholders at all levels.
• Strong analytical and problem-solving abilities.
• Proficiency with claims management software, data analysis tools, and project management applications.
• Report creation and presentation skills.
• Vendor management and conflict resolution skills.

Abilities

• Strategic planning aligned with organizational goals.
• Adaptability to dynamic environments.
• Attention to detail and compliance.
• Decisiveness in high-pressure situations.
• Stakeholder relationship cultivation.

Qualifications & Education

Bachelor’s degree in Business Administration, Information Systems Management, Health Information Management, or related field. Must have:

• Seven years of data systems management experience, preferably in claims or health insurance.
• At least five years in a supervisory/managerial role.

Physical Requirements

• Visual acuity for document review and computer use.
• Physical activity includes crouching, reaching, walking, talking, hearing, and repetitive hand motions.
• Sedentary work with lifting up to 10 pounds, sitting for extended periods.
• Mental concentration is essential.

Residency Requirement

Must reside in NC, SC, GA, TN, VA, MD, or FL.

Salary

Dependent on qualifications and experience. This position is exempt and not eligible for overtime.

Application Process

Apply online via Vaya Health’s Career Center: https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.