Senior Product Owner (Claims)(Onsite)

Simplify Alpha; Northern (KY); Hybrid; USD 120,000 - 180,000; Full time

Job summary

Simplify Alpha is seeking a Senior Product Owner to join the Claims Adjudication Platform team onsite. You will help shape and drive the modernization roadmap, working day-to-day with product owners, engineering leads, and health plan stakeholders to deliver value.

You will own the backlog for claims processing modules, write detailed epics and user stories, and ensure acceptance criteria meet regulatory and contractual intent.

Qualifications

• 8–12+ years in product ownership, product management, or senior business analysis in health plan/payer claims environments.
• Deep understanding of the claims lifecycle: intake, eligibility, adjudication, pricing, payment, COB, subrogation, appeals.

Responsibilities

• Partner with 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.

Skills

Product ownership

Claims domain knowledge

HIPAA/EDI compliance

Agile/Scrum

Stakeholder management

User stories & acceptance criteria

Tools

Jira

Confluence

Job description

The individual will be positioned directly alongside the platform team behind a large-scale Claims Adjudication Platform used by health plans to process and pay claims. The platform is in the middle of a multi-year modernization journey, and this role will help shape and drive that roadmap from the product side, working day-to-day with the platform's product owners, engineering leads, and health plan stakeholders. This is a hands-on, embedded product role.

Key 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, coordination of benefits (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.

Required Skills:

• 8-12+ years of experience as a Product Owner, Product Manager, or senior Business Analyst in health plan/ payer claims environments.
• Deep, practical 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.

Job Application –Senior Product Owner (Claims)(Onsite)