Product Manager, Capitation Adjudication (Remote)

IQVIA; United States; Remote; USD 88,000 - 220,000; Full time

Job summary

Cedar Gate Technologies, an IQVIA business, seeks a Product Manager to enhance and deliver the Capitation Adjudication platform. Ideal candidates have direct payer/managed care experience to guide requirements and collaborate with cross-functional teams.

The role entails defining requirements, supporting delivery, and ensuring the platform meets client and business needs, working with Product, Engineering, QA, Operations, Client Services, and Implementation teams.

Qualifications

• Bachelor's degree in Healthcare Administration, Information Systems, Business Administration, or related field, or equivalent experience.
• Seven or more years of experience in healthcare payer, managed care, or health plan operations.
• Five or more years of hands-on experience with Capitation Adjudication (EZ-CAP) in production.
• Experience supporting payer operations after go-live, including production support, issue resolution, process improvements, or system enhancements.
• Experience gathering business requirements and translating them into functional solutions.
• Strong understanding of healthcare claims processing, capitation administration, provider reimbursement, or managed care operations.
• Excellent communication, organizational, and stakeholder management skills.
• Experience working in Agile or Scrum-based software development environments.
• Experience supporting multiple functional areas within Capitation Adjudication, such as claims, authorizations, capitation, benefits, provider administration, or EDI is preferred.
• Experience with value-based care, risk-based payment models, or capitated products is highly preferred.
• Previous experience supporting Cedar Gate Technologies' Capitation Adjudication platform, EZ-Cap, from the client side, would be ideal.
• Experience participating in implementation projects, upgrades, conversions, or major system enhancements would be nice.
• Some familiarity with JIRA, Confluence, SQL, reporting tools, or healthcare operational reporting.
• Certified Scrum Product Owner (CSPO), Agile certification, or similar professional certifications are preferred.
• To be eligible for this position, you must reside in the same country where the job is located.

Responsibilities

• Manage and prioritize product enhancements and backlog items for the Capitation Adjudication platform.
• Gather, analyze, and document business requirements and operational use cases.
• Develop user stories, functional requirements, and acceptance criteria.
• Collaborate with engineering and quality assurance teams throughout the software development lifecycle.
• Participate in Agile planning activities, backlog refinement sessions, sprint reviews, and release preparation.
• Help evaluate product enhancements through the lens of real-world payer operations and client needs.
• Support implementation, testing, release readiness, and post-release activities.
• Partner with internal stakeholders to identify opportunities for product improvements and operational efficiencies.
• Assist with product demonstrations, client discussions, and subject matter expertise related to Capitation Adjudication functionality.
• Contribute to product roadmap planning through feedback from clients, operational teams, and market requirements.

Skills

Communication

Stakeholder management

Agile methodologies

Scrum

JIRA

Confluence

SQL

Reporting tools

CSPO

Education

Bachelor's degree in Healthcare Administration, Information Systems, Business Administration, or related field

Tools

JIRA

Confluence

SQL

EZ-CAP

Job description

Cedar Gate Technologies, an IQVIA business, seeks a Product Manager to enhance and deliver the Capitation Adjudication platform. Ideal candidates have direct payer/managed care experience to guide requirements and collaborate with cross-functional teams.

The role entails defining requirements, supporting delivery, and ensuring the platform meets client and business needs, working with Product, Engineering, QA, Operations, Client Services, and Implementation teams.