Senior Product Manager, Claims Platform Modernization

Simplify Alpha; United States; On-site; USD 110,000 - 150,000; Full time

Job summary

Simplify Alpha is seeking an embedded product leader to work alongside the platform team behind a large-scale health claims adjudication platform. You will drive the modernization roadmap with product owners, engineering leads, and health plan stakeholders.

This hands-on role requires deep claims domain knowledge, strong backlog discipline, and the ability to translate business rules into testable requirements while ensuring HIPAA compliance.

Qualifications

• 8-12+ years of experience as a Product Owner, Product Manager, or senior Business Analyst in health plan/ payer claims environments.
• Deep understanding of the claims lifecycle: intake, eligibility and benefits, adjudication, pricing, payment integrity, and appeals.
• Working knowledge of core healthcare EDI transactions (837, 835, 276/277, 278) and HIPAA transaction requirements.
• Experience writing detailed user stories and acceptance criteria for complex, rules-heavy systems.
• Comfort working directly with client stakeholders, including client-side product and engineering leadership.
• Solid agile/Scrum fundamentals, including backlog management tools such as JIRA and Confluence.
• Strong written and verbal communication skills; able to translate between business rules, technical constraints, and regulatory requirements.

Responsibilities

• Partner with the Claims Adjudication Platform's product, architecture, and engineering leads to define, sequence, and prioritize the modernization roadmap.
• Own and groom the product backlog for claims processing modules, writing clear epics, user stories, and acceptance criteria.
• Serve as the claims domain subject matter expert across the team, covering eligibility, benefits configuration, adjudication, pricing, payment, COB, subrogation, and appeals/grievances.
• Translate legacy platform business rules and edit logic into modernized, testable requirements without losing regulatory or contractual intent.
• Work directly with EDI transaction flows relevant to claims (837, 835, 276/277, 278) and ensure new capabilities stay compliant with HIPAA transaction standards.
• Facilitate backlog refinement, sprint planning, and other agile ceremonies; keep the team unblocked and focused on the highest-value work.
• Act as the primary point of contact between Simplify Alpha and the platform's leadership team on scope, tradeoffs, and delivery status.
• Define and validate user acceptance testing (UAT) criteria for claims outcomes before release.
• Identify risks and dependencies early, especially where modernization work touches downstream health plan operations.

Skills

Product ownership

Healthcare claims domain

HIPAA/EDI knowledge

User story writing

Stakeholder management

Agile/Scrum

Regulatory requirements

Communication skills

Tools

JIRA

Confluence

Job description

Simplify Alpha is seeking an embedded product leader to work alongside the platform team behind a large-scale health claims adjudication platform. You will drive the modernization roadmap with product owners, engineering leads, and health plan stakeholders.

This hands-on role requires deep claims domain knowledge, strong backlog discipline, and the ability to translate business rules into testable requirements while ensuring HIPAA compliance.