Product Manager, Medicare Enrollment & Benefits

HealthEdge

3d•Remote

About The Position

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, plan benefit packages and accumulator logic within the HealthRules Payer platform. You will partner cross-functionally with engineering, QA, implementation and client success to ensure enrollment and benefit design capabilities consistently reflect CMS regulatory requirements – enabling our health plan clients to configure, launch and administer Medicare benefit structures with speed and confidence.

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.

Nice To Haves

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.

Responsibilities

Own the end-to-end product requirements for Medicare FFS enrollment workflows, plan benefit package configuration, accumulator logic and benefit limit enforcement within HealthRules® Payer – ensuring clients operate in continuous alignment with CMS enrollment mandates.
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.