Join the Edison family of high-growth, market-leading companies in financial services, healthcare, enterprise software sectors.


Product Manager, Medicare Regulatory Pricer



Product, Legal
St. Petersburg, FL, USA · Petersburg, VA, USA · Texas, USA · Morristown, NJ, USA · Morristown, TN, USA · Texas, USA · Park, TX, USA · New Jersey, USA · Remote
Posted on Thursday, September 7, 2023

Position Overview

The Product Manager, Medicare Regulatory Pricer is a management role responsible for managing our core Medicare Pricer for the Claims Cost Solutions (CCS Division). You will be responsible for driving the integrity of the Medicare Pricer including the review, interpretation, and Medicare reimbursement updates. You will work with colleagues within Regulatory Pricing and Product leadership to help manage and run product planning processes and ensure that strategic goals and priorities are aligned across the organization.

To be effective in this unique role, the Product Manager, Medicare Regulatory Pricer must work well with a variety of groups and deliver outcomes that serve the business.

Key Responsibilities

  • Manage the CCS enterprise Medicare Pricer within the Visium platform

  • Translating the business needs into User Stories which the Agile team can understand and work from

    • Applying the concepts of Minimum Viable Product (MVP), to shape “what to work on next.”

    • Being able to take the initiative and make decisions, to keep the team moving forward.

  • Manage Medicare Pricer Program to ensure that the team consistently meets or exceeds milestone goals and metrics

  • Contribute to market-in primary and secondary product research

  • Prepare and communicate program level status reporting and metrics to key constituents, stakeholders, and executive team; produce product related reports and/or dashboards

  • Possess the ability take complex concepts and/or designs and distill them down to an easily digestible presentation for appropriate audience

  • Work with Product Leadership to ensure process, procedures, and tools for the execution of the Product roadmap are effective and efficient

  • Support launch and delivery activities of new products and releases

  • Serve as a subject matter expert for Medicare program and provide support where needed including sales, client facing teams and clients

  • Continuous improvement and refinement on tests based on pre-production validation, post-production results and feedback from other groups (Configuration Department, Research Department and Operations teams) as needed

  • Participate in Incident Management, Problem Management, and Continual Service Improvement activities as needed

  • Keep abreast of issues to identify enhancements and process improvement opportunities

  • Actively contribute innovative ideas and support ad hoc projects, including time-sensitive requests

  • Accurately scopes out projects, sets objectives, and goals, develops schedules, measures performance against goals, and evaluates results

Required Qualifications

  • 5-10+ years of Medicare Program experience

Preferred Qualifications

  • Bachelor’s Degree in business, healthcare, or technology

  • Pragmatic Marketing certification

  • Experience within the healthcare industry

  • Experience with the Altassian suite of products (Jira, Confluence, etc.) and/or Product Board

  • Agile software development methodology experience

  • Financial modeling experience and strong analytic skills

  • Demonstrated leadership ability with cross-functional teams, ability to get things done both through formal channels and the informal network

  • Ability to think and act strategically, and as well as execute tactically with bias toward action

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

Commitment to Diversity, Equity, Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.