Product Manager - TPA & Provider Solutions

Product Manager, TPA & Provider Solutions

The Product Manager, TPA and Provider Solutions is responsible for helping build and grow our end to end payor and provider products that increase referrals, protect and grow our provider network, and streamline administrative and financial processes.  The role helps drive two charges: 1) build seamless and optimized front end provider experiences for providers and operational experiences for internal stakeholders, and 2) enable high quality data foundations that drive our member, provider, and client/partner operations. This role will help shape and evolve the product function towards better processes, tooling, and execution as we aim to continuously improve our craft.

Responsibilities:

• Discovery: Perform deep discovery and user research with stakeholders, members, internal users, while taking into account legal, regulatory and competitive and market dynamics. Bring qualitative and quantitative insights to the table for discussion
• Strategy: create and drive the Provider Experience product strategy coupling the front-end user/member experience with a world class care team service experience. Collaborate and align strategy with relevant stakeholders including presenting to and working with senior leadership.
• Roadmap: create, align, and provide cross org visibility to TPA & Provider Solutions roadmap.
• Alignment: create top down and bottoms-up alignment ensuring your direct, peers, teams, and senior leadership are providing the right level of guidance in accordance with RACI or similar.
• Experimentation: Set the bar for when and where to experiment. Bring a data-driven approach to building product, but leverage your experience and product sense to deliver the right products on time and in budget. Perform rapid experimentation where needed, test manually, build stat sig experiments that prove and disprove our hypthoesis
• Approach: Apply product led growth concepts, letting our users (internal/external) shape our Analyze existing products, make the tough calls, say no, and create pitches and actionable plans for implementing new features. Make smart decisions applying 1 vs. 2 way door framework
• Process: Refine and build process as needed to ship high quality products on time and in budget while ensuring visibility and alignment across the org. Manage the product development process and timeline to ensure targets are met on time and in budget
• Provider Experience:
• Eligibility
• Billing & claims
• Data and systems: we ingest multiple data sources – eligibility, claims, prior authorization feeds to drive our systems. Through our growth we have been scrappy to win business as the opportunity allowed. Going forward we need to set specific standards and rules for the future to reduce operational overhead and increase simplicity in our service offering.
• Internal tools and systems: we have a number of internal tools and systems that service different parts of the business for example identifying provider / facility targets, credentialing providers etc. These systems need to be refined and developed to increase the productivity of the owning business team
• Data activations/insights: leverage key data and insights to keep members informed, engaged, and able to perform key tasks (e.g. provide preferences, select a provider, pay a bill etc..)
• Partnership Integrations: Support the member experience in conjunction with relevant integrations through health plans and digital health partners
• Reporting: Create scalable, accurate, differentiated internal and external reporting
• Internal: Executive Dashboards/ KPI visualization
• External: Client Reporting as a Product

Requirements

Benefits