Product Manager, Eligibility & Coverage

Quick Facts

• Role: Product Manager, Eligibility & Coverage

• Focus: Eligibility verification, coverage discovery, and benefits summarization/interpretation for hospitals and health systems

• Team: Independently lead an engineering team of ~3–8 engineers

Description

Own the strategy and roadmap for products that help hospitals verify patient insurance eligibility, discover undisclosed coverage, and understand a patient’s complete benefits picture. Guide delivery and quality decisions, and partner with engineering and design to integrate new payer connections and data sources. Use analytics (increasingly AI-accelerated) and agentic AI tooling to improve response accuracy and inform product decisions.

Responsibilities

• Own eligibility verification, coverage discovery, benefits summarization and interpretation, and payer connectivity/data-source capabilities

• Drive market research and data analysis to identify customer needs and trends; build business cases for high-impact initiatives (e.g., expanding payer coverage, adding data sources)

• Monitor product and payer-response performance using analytics to detect incomplete/ambiguous/incorrect responses and validate improvements to coverage discovery accuracy

• Independently lead an engineering team (~3–8) and own delivery and quality decisions

• Partner with engineering/design leadership on complex trade-offs for new payer integrations and eligibility data sources

• Use agentic AI and dev-integrated tools (e.g., Cursor, Cowork) to accelerate discovery, requirements, and prototyping; identify opportunities to responsibly embed AI in the product

• Lead customer meetings, present the roadmap, gather feedback, and negotiate competing requests

• Manage relationships across engineering, compliance, payer operations, and external health-system/payer partners; apply healthcare regulatory knowledge (HIPAA, X12 EDI standards, CMS interoperability rules) to manage compliance and risk

Requirements

• 3+ years of product management experience owning a product area end-to-end

• Healthcare IT, revenue cycle management (RCM), or health insurance/payer operations experience; patient eligibility verification (270/271 EDI transactions) or coverage discovery strongly preferred

• Experience independently guiding an engineering team (~3–8) and owning a product roadmap

• Data analysis experience, including AI-assisted analysis, to validate assumptions and prioritize decisions

• Experience leading customer-facing meetings, presenting roadmaps, and negotiating scope with external stakeholders

• Hands-on experience with AI tools: chat-based assistants, agentic tools, and dev-integrated/prototyping tools

• Familiarity with healthcare regulatory/data-protection requirements (HIPAA, EDI standards)

• Reside in or near the designated collaboration hubs

Benefits

• Great compensation package and bonus plan

• Core benefits: medical, dental, vision, and matching 401(k)

• Flexible work environment; ability to work remote, hybrid, or in-office

• Flexible time off including volunteer time off, vacation, sick time, and 12 paid holidays

• Variable pay opportunity