About the RoleWe are seeking an experienced Healthcare Product Owner to lead the product backlog for our Capitation and Provider Payments platform. This role is responsible for driving end-to-end product delivery across systems and processes supporting provider capitation payment calculation, reconciliation, and disbursement.The ideal candidate will possess a deep understanding of healthcare payer capitation processes—from member and provider assignment through payment calculation, reconciliation, and provider payments. The Product Owner will work closely with business and engineering teams to translate business problems into actionable product requirements, ensure delivered solutions meet business objectives, and lead User Acceptance Testing (UAT) through production readiness.Key Responsibilities
- Own, prioritize, and manage the product backlog for capitation systems and provider payment workflows.
- Develop deep end-to-end knowledge of the capitation lifecycle, including:
- Eligibility and enrollment
- Member and provider assignment
- Provider contracts
- Rate methodologies
- Payment calculation
- Reconciliation
- Provider disbursement
- Collaborate with Finance, Provider Network, Actuarial, Operations, and Technology teams to understand business needs and convert them into Epics, Features, User Stories, and Acceptance Criteria.
- Serve as the primary liaison between business stakeholders and engineering teams to ensure delivered solutions solve the intended business problems.
- Lead Agile ceremonies including:
- Sprint Planning
- Backlog Grooming/Refinement
- Sprint Reviews
- Retrospectives
- Own the User Acceptance Testing (UAT) process by:
- Defining UAT strategy
- Creating test scenarios
- Coordinating testing activities
- Managing defect triage
- Driving final business sign-off
- Validate that completed features satisfy acceptance criteria and business objectives before release.
- Identify process gaps, operational risks, and improvement opportunities within capitation workflows.
- Recommend solutions to improve payment accuracy, processing timelines, reconciliation, auditability, and operational efficiency.
- Ensure compliance with CMS regulations, Medicare/Medicaid guidelines, HIPAA requirements, and provider contractual obligations.
- Define and monitor KPIs including:
- Payment accuracy
- Reconciliation turnaround time
- Defect leakage from UAT to Production
- Product delivery metrics
- Communicate project progress, risks, dependencies, and trade-offs to stakeholders and leadership throughout the product lifecycle.
Required Qualifications
- 5+ years of experience as a Product Owner, Business Analyst, Product Manager, or similar Agile role.
- Strong understanding of healthcare payer capitation and provider payment processes.
- Experience with:
- Member/provider assignment
- Rate configuration
- Payment calculation
- Financial reconciliation
- Provider disbursement
- Proven experience working directly with both business stakeholders and software engineering teams.
- Demonstrated experience leading User Acceptance Testing (UAT), including test planning, execution, defect management, and production sign-off.
- Strong experience writing:
- User Stories
- Acceptance Criteria
- Functional Requirements
- Product Backlog items
- Hands-on experience using Agile tools such as:
- Jira
- Azure DevOps
- Rally
- Good understanding of healthcare payer regulations including:
- CMS Guidelines
- Medicare
- Medicaid
- HIPAA
- Excellent communication, facilitation, stakeholder management, and analytical skills.
- Bachelor's degree in Business, Health Administration, Finance, Information Systems, or a related field (or equivalent practical experience).
Preferred Qualifications
- Direct experience working with healthcare payer capitation systems.
- Experience with provider contracts and capitation rate methodologies.
- Knowledge of provider financial reconciliation processes.
- Familiarity with healthcare EDI transactions and payer data exchanges.
- Experience working with:
- Eligibility systems
- Claims systems
- Provider payment platforms
- Prior experience leading UAT for financial or payment-related applications.
- Knowledge of defect management tools such as Jira, Zephyr, or qTest.
- Certified Scrum Product Owner (CSPO) or equivalent Agile certification.
Technical Skills
- Agile / Scrum Methodologies
- Product Backlog Management
- User Story Development
- Acceptance Criteria Definition
- UAT Planning & Execution
- Jira
- Azure DevOps
- Rally
- Healthcare Capitation
- Provider Payments
- Financial Reconciliation
- Medicare / Medicaid
- CMS Regulations
- HIPAA
- EDI Transactions
- Business Analysis
- Stakeholder Management
- Risk Management
- KPI Definition & Reporting
Soft Skills
- Strong leadership and ownership
- Excellent communication skills
- Strategic thinking
- Problem-solving mindset
- Cross-functional collaboration
- Negotiation and stakeholder management
- Attention to detail
- Process improvement orientation
- Ability to manage multiple priorities in a fast-paced Agile environment
What You'll BringYou are a customer-focused Product Owner who understands both the business and technical aspects of healthcare payer operations. You can bridge the gap between business stakeholders and engineering teams, ensuring that every delivered feature solves real business problems while maintaining regulatory compliance, operational excellence, and high-quality product delivery.This role offers an opportunity to drive the evolution of a mission-critical healthcare payment platform while working with cross-functional teams in a collaborative Agile environment.
Pay: $50.00 - $60.00 per hour
Work Location: Remote
