JOB SUMMARY
The Senior Product Manager, Claims will define the product strategy, vision, and value proposition of Highmark’s claims’ platforms for our customers - employers & members. This includes defining an experience strategy for a modern claims intake and processing platform, simplifying explanation of benefits for members, improving payment integrity, and optimizing the experience of denials, appeals, and grievances. The ideal candidate outlines the strategic vision and business case, gains alignment and support from key strategic partners and stakeholders, and oversees execution of that vision, while also providing coaching and guidance to junior team members. This incumbent will attend and participate in milestone reviews with the Delivery team.
A deep understanding of the health insurance claims process will be essential. This includes a strong grasp of claims intake, adjudication, payment, appeals, denials, and grievances along with familiarity with various claim types (medical, dental, pharmacy, etc.). Demonstrated success with leading claims transformations as well as experience with claims systems and technology will be essential. This includes knowledge of claims processing platforms, data management systems, and relevant technologies like AI/ML to optimize claims processing.
ESSENTIAL RESPONSIBILITIES
ADDITIONAL RESPONSIBILITIES
EXPERIENCE
To include:
Preferred
SKILLS
EDUCATION
Preferred
LICENSES or CERTIFICATIONS
None
Preferred
None
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office- or Remote-based
Teaches / trains others
Occasionally
Travel from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Occasionally
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Never
Lifting: 25 to 50 pounds
Never
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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