Senior Product Owner (Claims)(Onsite)
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, technicalconstraints, and regulatory requirements.