Product Development Coordinator​/Manager

Hiring a Product Development Manager with experience in the Health Plan, PBM, or Medicare Advantage space; experience coordinating offshore development teams; strong Agile/Scrum and SDLC knowledge.

100% remote in US only.

• Own the product strategy for claims intake, validation, adjudication, pricing, payment, remittance, audit, and related integrations (EHR, Enrollment, UM, Risk, Quality/NCQA, Coding Scrubber).
• Define and maintain a quarterly roadmap aligned to business OKRs, regulatory timelines, and client commitments; socialize priorities with Ops, Compliance, Finance, and Technology.

• Convert operational goals and regulatory constraints into epics, features, and user stories with clear acceptance criteria, edge cases, and non-functional requirements (auditability, throughput, privacy/security).
• Lead backlog grooming and sprint planning with offshore/onshore engineering; ensure requirements are unambiguous and testable.

• Serve as the product SME across the claims lifecycle; design claim edits and reference data strategies (NCCI, OCE, Medicare pricing rules, COB/TPL, provider/plan configuration).
• Specify and validate EDI/X12 transactions: 837 (P/I/D), 835, 270/271, 276/277, 278; coordinate with clearinghouses and trading partners.
• Support standards and interoperability (HL7/FHIR, NCPDP for pharmacy).

• Drive UAT with Claims Ops; establish and monitor release gates for compliance, performance, and data quality (PHI handling, audit logs, error rates).
• Partner with QA to design scenario-based test suites and data validation for adjudication rules, pricing, and remittance advice.

• Ensure end-to-end adherence to HIPAA/HITECH, CMS guidance (including Medicare Advantage considerations), ERISA/state requirements, and internal security controls (RBAC, audit trails).

• Define product metrics and dashboards (Power BI/Tableau) for auto adjudication rate, first pass yield, claim touch rate, cycle time, payment accuracy, denial/appeal patterns, and operational throughput.
• Collaborate with Data Engineering on pipelines, reconciliations, and exception management; drive root cause analysis for defects and leakage.

• Act as the day-to-day product point for Claims, Operations, Compliance, Client Services, and external vendors/clearinghouses; manage SLAs and integration timelines.
• Facilitate time‑aware ceremonies with the offshore dev team (4 FTEs) and coordinate closely with the onshore PM and developer.

• Lead discovery to simplify workflows and increase automation; champion process and UX enhancements for adjusters, billing teams, and provider/client interfaces.
• Maintain a living configuration playbook (plan/benefit setup, pricing rules, enrollment tie‑ins) to reduce errors and speed onboarding.

• 5–7+ years in product management or solutions leadership in healthcare payer/TPA/MSO environments with direct ownership of claims platforms.
• Practical experience with EDI/X12 (837/835/270/271/276/277/278), claim adjudication rules, benefit configuration, and clearinghouse integrations.
• Proven ability to translate business/regulatory requirements into product specs and collaborate with engineering to ship iterative releases.
• Strong grounding in HIPAA, data privacy/security, and audit/compliance practices.

• Exposure to Medicare Advantage operations and CMS timelines; familiarity with NCQA quality programs and utilization management touchpoints.
• Technical fluency with one or more of:
  Azure, .NET/C#, Python, SQL; tooling like Azure Dev Ops/Jira/Confluence, Power BI/Tableau.
• Working knowledge of ICD‑10, CPT/HCPCS, DRG/APC, provider contracting/pricing, COB/TPL, prior authorization workflows.
• Experience collaborating with offshore engineering teams, managing cross‑time‑zone delivery.

Determining compensation for this role (and others) at Vaco/Highspring depends upon a wide array of factors including but not limited to the individual’s skill sets, experience and training, licensure and certifications, office location and…