Senior Product Manager - Health Plan Data & AI Products

AIToolboard; Columbia (SC); On-site; USD 140,000 - 190,000; Full time

Benefits offered by this job

Support from Bessemer Venture Partners

Forge

Job summary

Medisolv is seeking a Senior Product Manager for Health Plan Data and AI Products to drive data-driven decisioning, align AI initiatives with CMS measure logic, and collaborate with engineering, AI, and clinical teams. You will lead data product development that improves Star Ratings and value-based care outcomes.

The role demands deep health plan data expertise, risk adjustment understanding, and experience building proactive software that automates workflows rather than only reporting results.

Qualifications

• 5+ years in product management for health plan data and VBC metrics.
• Deep understanding of CMS MA Star Ratings and risk adjustment.
• Experience with claims, eligibility, and enrollment datasets mapped to quality.
• Knowledge of GenAI architectures, RAG, and agent frameworks.

Responsibilities

• Understand Medisolv's data ecosystem and CMS measure logic.
• Collaborate with engineering, AI, and clinical stakeholders on priorities.
• Define initial AI agent architecture with HITL safety and compliance.
• Prototype AI agents to identify care gaps and predict Star Rating risks.
• Stand up the payer data core from fragmented datasets.
• Develop CMS measure engines and pilot action-oriented workflows.
• Deploy production-ready AI agents linking insights to actions.
• Mature the data platform into a real-time decisioning engine.
• Drive improvements in Star Ratings and value-based care outcomes.

Skills

Product management

Healthcare data

VBC metrics

CMS Star Ratings

AI product design

Tools

LangChain

AutoGen

APIs

Vector databases

Job description

Jobs / Senior Product Manager - Health Plan Data & AI Products

Senior Product Manager - Health Plan Data & AI Products

Full-time

About the Role

About the positionMedisolv partners with hospitals, health systems, ACOs, and payers to bring clarity to quality data, connecting clinical and claims information into a single, reliable view. Over 1,800 organizations and 130M+ patient records rely on Medisolv to measure, report, and improve performance across 500+ measures tied to CMS, The Joint Commission, and other programs. With support from Bessemer Venture Partners Forge, Medisolv is continuing to grow its platform and expand its impact by investing in advanced analytics, AI, and new capabilities that help healthcare organizations stay ahead of change and improve outcomes with confidence. This role is for someone who knows the health insurance and VBC worlds inside out, understands the math behind CMS quality calculations, and is excited about putting autonomous AI agents to work on healthcare data.

Responsibilities

• Build a deep understanding of Medisolv’s data ecosystem and CMS measure logic (HEDIS, Pharmacy, CAHPS/HOS).
• Align with engineering, AI, and clinical stakeholders on priorities and high-impact use cases.
• Define initial AI agent architecture and guiding principles for HITL safety and compliance.
• Design and prototype AI agents to identify care gaps and predict Star Rating risks.
• Stand up the foundation of the payer data core from fragmented datasets.
• Develop initial CMS measure calculation engines and pilot action-oriented workflows.
• Deploy production-ready AI agents that connect insights directly to gap-closing actions.
• Expand and stabilize the payer data core and measurement automation.
• Implement orchestrated workflows and mature HITL guardrails.
• Optimize AI performance with feedback loops and expand to more advanced use cases.
• Mature the data platform into a scalable, real-time decisioning engine.
• Drive measurable improvements in Star Ratings and value-based care outcomes.

Requirements

• 5+ years of product management experience handling health plan data and VBC provider quality metrics.
• Deep understanding of risk adjustment, utilization management, and how risk-bearing entities operate.
• Expertise in how CMS calculates MA Star Ratings, including the math behind cut points and the impact of triple-weighted measures.
• Ability to build data products that move the needle across various CMS measure domains.
• Hands-on experience working with claims, eligibility, and enrollment datasets, and mapping them back to quality performance.
• Experience building proactive software that thinks, adapts, and automates workflows, rather than just reporting on them.
• Understanding of GenAI architectures, RAG, and agentic frameworks (like LangChain, AutoGen, or similar orchestration toolsets).
• Comfortable talking to engineers about vector databases, APIs, and semantic data layers.
• Understanding of HIPAA/HITRUST guidelines and how to build AI outputs that are accurate, unbiased, and explainable.
• Takes initiative and enjoys driving tasks from inception to completion.
• Demonstrates and influences cross-functional collaboration within the company.
• Seeks out opportunities to build relationships with others even when difficult personalities or politics stood in the way.
• Flexibility and adaptability to changing environments as a company grows and scales.
• Intellectual curiosity and a love for figuring out how things work.
• Resilience and optimism; embraces change.

Nice-to-haves

• Experience with Bessemer Venture Partners Forge.
• Experience with autonomous AI agents.

Benefits

• Support from Bessemer Venture Partners Forge