Product Manager, Medicare Enrollment & Benefits

HealthEdge is seeking a Product Manager with deep expertise in Medicare Fee-for-Service enrollment operations and benefit design to join the HealthRules® Payer product team. In this role, you will own the product requirements that govern how health plans configure and administer Medicare FFS enrollment transactions and plan benefit packages.

Responsibilities:

• Own product requirements for Medicare FFS enrollment workflows within HealthRules Payer, including enrollment transaction processing, plan benefit package configuration and enrollment reconciliation against CMS enrollment data
• Define system behavior requirements for benefit design parameters including cost-sharing structures, benefit period logic, coverage exceptions and benefit limit enforcement as configured in HealthRules Payer
• Drive accumulator configuration requirements for deductible, out-of-pocket maximum and benefit limit tracking across claim types, benefit periods and coordination of benefits scenarios within the HealthRules Payer accumulator framework
• Evaluate CMS rulemaking cycles and annual benefit design updates to assess downstream impact on HealthRules Payer configuration and adjudication behavior, translating mandates into structured product requirements and acceptance criteria
• Maintain a benefit design and enrollment change calendar aligned to CMS implementation timelines, sequencing HealthRules Payer releases to support client change readiness
• Partner with implementation and client success teams to validate HealthRules Payer benefit configuration output against CMS enrollment records and member cost-sharing expectations, driving gap resolution through the product backlog
• Serve as the embedded Medicare enrollment and benefit design SME, triaging and prioritizing regulatory-driven backlog items in collaboration with engineering and QA through resolution

Requirements:

• 5+ years of product management or equivalent experience in healthcare payer operations, Medicare FFS benefit administration or health plan enrollment processing
• Deep working knowledge of Medicare FFS plan benefit package structure, CMS enrollment transaction requirements and annual benefit design update cycles
• Experience translating CMS regulatory requirements into structured product requirements, user stories and acceptance criteria in an Agile development environment
• Strong understanding of accumulator mechanics – deductible, out-of-pocket maximum and benefit limit tracking across multiple claim types and benefit periods
• Familiarity with coordination of benefits (COB) rules and their interaction with Medicare FFS benefit design configurations
• Exceptional collaboration and communication skills with the ability to align engineering, implementation and client stakeholders around a shared benefit design roadmap
• Direct experience with HealthRules Payer or similar core administrative processing (CAPS) platforms
• Knowledge of CMS enrollment reconciliation processes and MA plan benefit package submission requirements
• Background in health plan implementation, benefit configuration or member services in a SaaS payer technology environment
• Familiarity with 834 enrollment transaction standards and CMS enrollment data validation requirements