This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. The Claims Administrator Product Owner is responsible for guiding the development, delivery, and evolution of Medicaid Claims Administration capabilities with a strong focus on QNXT, medical claims policy adjudication, and pharmacy related claims administration.

• Acting as the primary bridge between clients, operations, policy, and engineering teams.
• Owns the end-to-end Claims Administrator product backlog.
• Ensures accurate, compliant, and scalable adjudication for medical and pharmacy claims.
• Emphasizes practical execution in live client environments.
• Shapes the longer-term modernization and evolution of the Claims Administration platform.

Key Responsibilities

• Product Strategy & Management
  • Own the product vision, roadmap, and backlog for QNXT based Claims Administration module.
  • Translate complex business and regulatory requirements into actionable user stories and features.
  • Own and manage the product backlog, ensuring it reflects business value, stakeholder input, and technical feasibility.
  • Continuously groom the backlog based on changing needs, emerging priorities, and iterative feedback.
  • Develop and maintain Product Roadmaps aligned with other related and critical Product areas.
• Cross-Functional Collaboration
  • Act as a liaison between internal development teams and external stakeholders.
  • Participate in Agile practices such as sprint planning, backlog refinement, reviews, and retrospectives.
  • Provide day-to-day direction to development teams, answer questions, and clarify user stories.
  • Ensure the final product meets quality expectations, user needs, and compliance requirements.
• Claims Administrator Subject Matter Expertise
  • Ensure accurate implementation of Medicaid policy, CMS guidance, and state-specific rules.
  • Provide deep functional guidance on claims scenarios, edge cases, and exception handling.
  • Support defect triage and prioritization related to claims adjudication issues.
  • Support and evolve pharmacy related claims administration capabilities.
  • Partner with pharmacy SMEs, operations, and technical teams for alignment.
  • Incorporate pharmacy policy changes and operational needs into backlog prioritization.
  • Participate in client discussions, demos, and working sessions.
  • Collaborate with implementation teams to reduce customization and improve configurability.

Qualifications

• 5+ years of experience as a Product Owner, Business Analyst, or Product Manager, preferably in the Medicaid or broader public health sector.
• Solid understanding of Medicaid Programs, Policies, and Business Processes.
• Strong experience working within Agile/Scrum Environments.
• Proficient in Backlog Management, Requirements Gathering, and Stakeholder Communication.
• Hands-on experience with Claims Administrator, QNXT, and other related Medicaid Claims Processing Related Applications.
• Excellent organizational, presentation, analytical, and interpersonal skills.

Requirements

• Primarily remote; occasional travel may be required.
• Video cameras must be used during all interviews and the initial week of orientation.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies to help build your skills and capabilities.