Product Manager, Payment Integrity

Remote

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Candidates should have at least 5 years of experience in healthcare product management, consulting, or a similar role, with a minimum of 2 years managing structured prioritization processes. A Bachelor's degree and experience with healthcare data, including claims, EDI transactions, and coding standards, as well as familiarity with health plan and provider network concepts, are required. Experience with payment integrity, revenue cycle management, health plan operations, claims processing, Jira, managing vendor relationships, working with technical and non-technical stakeholders, Agile methodologies, and the SDLC are considered advantageous.

Responsibilities

The Product Manager, Payment Integrity will create and manage a roadmap for payment integrity capabilities, including code editing, bill review, fraud detection, subrogation, and coordination of benefits, to ensure accurate medical claim payments. Responsibilities include defining requirements, evaluating vendors, creating user stories, collaborating with various teams, and monitoring performance dashboards. The role involves developing systems to identify and adjust incorrect claims, setting and tracking operational and financial goals, reviewing vendor and internal capability performance, staying updated on industry innovations and regulations, and ensuring compliance with best practices.

Skills

Payment Integrity

Roadmap Creation

Requirements Definition

Vendor Evaluation

User Stories

Claim Editing

Bill Review

Fraud Detection

Waste Detection

Abuse Detection

Subrogation

Coordination of Benefits

Data Analysis

Performance Monitoring

Gravie

Health benefits and insurance solutions provider

About Gravie

Gravie provides health benefits by offering straightforward and affordable health plans, primarily targeting individuals and small to midsize businesses. Their main product, Comfort, stands out because it has no deductible and no copays for most common healthcare services, allowing members to access care without unexpected costs. Additionally, Comfort includes virtual care options for musculoskeletal and mental health issues. Gravie also offers a payment solution called Gravie Pay, which enables members to pay for healthcare expenses interest-free, further easing financial stress. Unlike traditional health plans, Gravie claims that Comfort members save on out-of-pocket costs, and employers switching to Gravie often see lower premium expenses. The company has a high retention rate, indicating that many employees choose to continue with the Comfort plan in subsequent years. Gravie's goal is to simplify health benefits and reduce the financial burden of healthcare for its members.

Minneapolis, MinnesotaHeadquarters

2013Year Founded

$333.3MTotal Funding

DEBTCompany Stage

Fintech, HealthcareIndustries

201-500Employees