Product Owner - Claims Administrator

Summary

The Claims Administrator Product Owner is responsible for guiding the development, delivery, and evolution of Medicaid Claims Administration capabilities with a strong focus on QNXT, medical claims policy adjudication, and pharmacy related claims administration. This role supports both active production clients and clients in implementation, ensuring that claims functionality meets regulatory requirements, operational realities, and contractual commitments while advancing the future-state vision of the platform.

Acting as the primary bridge between clients, operations, policy, and engineering teams, the Product Owner owns the end-to-end Claims Administrator product backlog and ensures accurate, compliant, and scalable adjudication for medical and pharmacy claims. The role emphasizes practical execution in live client environments while also shaping the longer-term modernization and evolution of the Claims Administration platform. 

Your role in our mission

Key Responsibilities:

Product Strategy & Management

• Own the product vision, roadmap, and backlog for QNXT based Claims Administration module, with emphasis on medical claims policy adjudication and pharmacy claims integration.
• Translate complex business and regulatory requirements into actionable user stories and features with clear acceptance criteria.
• Own and manage the product backlog, ensuring it reflects business value, stakeholder input, and technical feasibility.
• Continuously groom the backlog based on changing needs, emerging priorities, and iterative feedback.
• Develop and maintain Product Roadmaps aligned with other related and critical Product areas – working closely with Product Managers and other Product Owners.
• Focusing and leading the future strategy and needs of the solution area this individual would be responsible for.

Cross-Functional Collaboration

• Act as a liaison between internal development teams and external stakeholders to ensure shared understanding of priorities and goals.
• Participate in Agile practices such as sprint planning, backlog refinement, reviews, and retrospectives to guide delivery and maximize team output.
• Provide day-to-day direction to development teams, answer questions, and clarify user stories as needed to unblock progress.
• Ensure the final product meets quality expectations, user needs, and compliance requirements specific to Medicaid programs.
• Collaborating on sales activities and meeting client needs

Claims Administrator Subject Matter Expertise

• Ensure accurate implementation of Medicaid policy, CMS guidance, and state‑specific rules within QNXT claims processing.
• Provide deep functional guidance on claims scenarios, edge cases, and exception handling to support reliable adjudication in production environments.
• Support defect triage and prioritization related to claims adjudication issues impacting active clients.
• Support and evolve pharmacy related claims administration capabilities, including integration points between pharmacy systems and core claims processing.
• Partner with pharmacy SMEs, operations, and technical teams to ensure alignment between medical and pharmacy adjudication, reporting, and financial reconciliation.
• Incorporate pharmacy policy changes and operational needs into backlog prioritization and platform enhancements.
• Participate in client discussions, demos, and working sessions to explain claims functionality, roadmap direction, and platform capabilities.
• Collaborate with implementation teams to reduce customization, improve configurability, and accelerate onboarding of new clients.

What we're looking for

• 5+ years of experience as a Product Owner, Business Analyst, or Product Manager, preferably in the Medicaid or broader public health sector
• Solid understanding of Medicaid Programs, Policies, and Business Processes such as Eligibility, Claims, Encounters, Prior Authorization, or Provider Management
• Strong experience working within Agile/Scrum Environments
• Proficient in Backlog Management, Requirements Gathering, and Stakeholder Communication
• Hands-on experience with Claims Administrator, QNXT, and other related Medicaid Claims Processing Related Applications
• Excellent organizational, presentation, analytical, and interpersonal skills

What you should expect in this role