Product Manager, Claims

XO Health believes healthcare is fixable. Become part of the community changing the face of the industry. XO Health is the first health plan designed by and for self-insured employers that delivers a more unified health experience for everyone – from those who receive care, to those who deliver it, to those who pay for it.

XO Health is building its own claims processing platform to power a new generation of claims adjudication, pricing, and payment. The Product Manager for Claims will own the product vision and strategy for this build, translating complex claims operations, EDI, and payer requirements into a clear roadmap the technical team can execute against.

This role sits at the intersection of the business and engineering. The Product Manager will partner closely with Claims Operations, EDI, Network, and Compliance stakeholders to understand real-world claims workflows, translate that knowledge into detailed, clear business requirements, and serve as the primary liaison between the business and the technical build team throughout design, development, testing, and launch.

This position requires strong product management fundamentals, deep curiosity about claims and healthcare operations, and the judgment to set realistic timeline goals and tradeoffs on a platform that directly affects members, providers, and payment accuracy.

Responsibilities:

• Product Vision & Strategy

  • Define and own the product vision and strategy for XO Health's claims processing platform, in partnership with Engineering, Claims Operations, and executive stakeholders.
  • Build and maintain the product roadmap for the claims platform, planning out the right order to build adjudication logic, while integrating pricing, EDI transactions, and payment features.
  • Set timeline goals and milestones for the claims build, balancing business urgency, technical feasibility, and dependencies across teams.
  • Translate long-term strategy into sprint-level priorities, and communicate tradeoffs clearly to leadership when scope, timeline, or resourcing conflicts arise.

• Business Requirements & Technical Liaison

  • Serve as the primary liaison between business stakeholders and the technical/engineering team throughout the claims build.
  • Draft detailed, clear business requirements and user stories for claims adjudication, pricing, EDI transaction handling (837, 835, 834), and claim adjustment workflows.
  • Translate complex claims processing rules (CARC/RARC and group codes, duplicate detection, accumulator management, medical necessity edits, correct-coding logic, workflow design, and business rules) into requirements engineers can build against.
  • Partner with engineering on solution design, review technical approaches for feasibility, and flag business risk or compliance concerns early.
  • Own acceptance criteria and participate in user acceptance testing (UAT) to confirm that delivered functionality meets business intent before release.

• Discovery, Prioritization & Backlog Management

  • Conduct discovery with cross-functional teams to surface pain points, edge cases, and process gaps in current claims handling.
  • Identify, manage, and mitigate risks/dependencies to ensure a successful release.
  • Own and groom the product backlog, prioritizing features and fixes based on business impact, regulatory requirements, and platform dependencies.
  • Define and track success metrics for the claims platform build, including accuracy, turnaround time, auto-adjudication rate, and denial/appeal volume.

• Cross-Functional Collaboration

  • Collaborate with Claims Operations, EDI, Network, Compliance, Legal, and Client-facing teams to ensure the claims platform reflects real operational and contractual needs.
  • Partner with vendor management and clearinghouse/EDI partners on transaction standards, connectivity, and migration workstreams.
  • Coordinate with Data, Analytics, and Reporting teams to ensure the claims platform supports downstream reporting, audit, and regulatory needs.
  • Communicate roadmap status, risks, and decisions clearly to stakeholders and leadership across the organization.

• Launch, Adoption & Continuous Improvement

  • Plan and support release management, including phased rollouts, provider/client communication, and training materials for internal teams.
  • Monitor platform performance and user feedback post-launch, and maintain a continuous improvement backlog.
  • Identify recurring issues, platform gaps, or process inefficiencies and drive resolution with the technical team.
  • Document product decisions, business requirements, and process changes to support institutional knowledge and audit needs.

We’re Looking for Candidates Who Have:

• The qualified candidate will have:

  • Experience in US healthcare, health insurance, claims operations, or employee benefits with working knowledge of the claims lifecycle, adjudication, and payment processes.
  • 5+ years of product management experience, including experience owning a product roadmap and strategy from discovery through launch.
  • Demonstrated ability to draft clear, detailed business requirements and user stories, and to serve as a liaison between business stakeholders and technical teams.
  • Strong analytical and problem-solving skills, with the ability to translate complex operational rules into structured product requirements.
  • Experience managing a product backlog and roadmap, setting priorities, and communicating timeline tradeoffs to stakeholders and leadership.
  • Excellent written and verbal communication skills, with the ability to work cross-functionally across business, operations, and engineering teams.
  • Comfort operating in an ambiguous, fast-paced environment where the tools and processes are still being built.

• Preferred Skills:

  • Bachelor's degree in business, health administration, computer science, or a related field.
  • Experience with claims adjudication platforms, claims pricing engines, and EDI transaction standards (837, 835, 834, 277).
  • Familiarity with CARC/RARC denial coding, UB-04 and CMS-1500 claim forms, and claims adjustment workflows.
  • Experience working with self-funded health plans, TPAs, or value-based care organizations.
  • Familiarity with Agile/Scrum product development practices and tools.
  • Experience partnering with clearinghouses, payer portals, or claims vendors.

• Additional Details:

  • Must be able to support USA business hours, with flexibility for cross-functional and vendor meetings.
  • May require occasional collaboration outside standard hours to support key releases or milestones.