Product Manager - TPA & Provider Solutions
2024-05-07
USA
Employer Direct Healthcare
About Employer Direct Healthcare
Employer Direct healthcare (EDH) is on a mission to transform access to excellent care for the moments that matter most. As the leading provider of surgical benefits for self-insured employers, we bring guided access to high-quality, affordable care for employers, their employees and the family members. We understand and have experienced the challenges of navigating specialized healthcare and we are dedicated to making a change.
EDH is the market leader for Independent Centers of Excellence (CoE). We have challenged the status quo in healthcare by bringing top quality surgeons within reach of all. Our surgeon-first model is the largest and most accessible network (3-4x larger than our peers), which has delivered an ROI 3x our peers. We serve hundreds of self-funded plan sponsors across 1000+ employers, representing over 4 million people across the U.S. We've saved our clients over $700 million since we were founded!
Ultimately, the US healthcare system at-large is flawed. Costs continue to rise while life expectancy stagnates. We are moving the needed on this problem by improving surgery outcomes - making people healthier - and lowering healthcare costs at the same time.
About You:
You have a drive and AMBITION to tackle big problems. Big problems require big ideas and a team that supports new ideas.
You CARE deeply for your customers. Your customers aren’t just the individuals using your product. They are the driving factor in your motivation to make a change.
You thrive in a TEAM ENVIRONMENT. Collaboration is key in innovation and creating change.
A DIVERSE environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives & you cherish the differences in each individual that you interact with.
You are DETAIL ORIENTED, but more so, focus on the execution of your content while balancing a fast-paced environment.
You understand that PROGRESS is critical to making change. You take the time to celebrate the small and big wins. Understanding that each improvement to a process helps move towards a greater change.
INTEGRITY guides you in life. Focusing on the truth versus just giving people the answers they want to hear.
If this sounds like you, we would love to connect to speak further about career opportunities at Employer Direct Healthcare.
Please apply to our role & someone from our HR Team will reach out to help you navigate our interview process.
Product Manager, TPA & Provider Solutions
The Product Manager, TPA and Provider Solutions is responsible for helping build and grow our end to end payor and provider products that increase referrals, protect and grow our provider network, and streamline administrative and financial processes. The role helps drive two charges: 1) build seamless and optimized front end provider experiences for providers and operational experiences for internal stakeholders, and 2) enable high quality data foundations that drive our member, provider, and client/partner operations. This role will help shape and evolve the product function towards better processes, tooling, and execution as we aim to continuously improve our craft.
Responsibilities:
Discovery: Perform deep discovery and user research with stakeholders, members, internal users, while taking into account legal, regulatory and competitive and market dynamics. Bring qualitative and quantitative insights to the table for discussion
Strategy: create and drive the Provider Experience product strategy coupling the front-end user/member experience with a world class care team service experience. Collaborate and align strategy with relevant stakeholders including presenting to and working with senior leadership.
Roadmap: create, align, and provide cross org visibility to TPA & Provider Solutions roadmap.
Alignment: create top down and bottoms-up alignment ensuring your direct, peers, teams, and senior leadership are providing the right level of guidance in accordance with RACI or similar.
Experimentation: Set the bar for when and where to experiment. Bring a data-driven approach to building product, but leverage your experience and product sense to deliver the right products on time and in budget. Perform rapid experimentation where needed, test manually, build stat sig experiments that prove and disprove our hypthoesis
Approach: Apply product led growth concepts, letting our users (internal/external) shape our Analyze existing products, make the tough calls, say no, and create pitches and actionable plans for implementing new features. Make smart decisions applying 1 vs. 2 way door framework
Process: Refine and build process as needed to ship high quality products on time and in budget while ensuring visibility and alignment across the org. Manage the product development process and timeline to ensure targets are met on time and in budget
Provider Experience:
Eligibility
Billing & claims
Data and systems: we ingest multiple data sources – eligibility, claims, prior authorization feeds to drive our systems. Through our growth we have been scrappy to win business as the opportunity allowed. Going forward we need to set specific standards and rules for the future to reduce operational overhead and increase simplicity in our service offering.
Internal tools and systems: we have a number of internal tools and systems that service different parts of the business for example identifying provider / facility targets, credentialing providers etc. These systems need to be refined and developed to increase the productivity of the owning business team
Data activations/insights: leverage key data and insights to keep members informed, engaged, and able to perform key tasks (e.g. provide preferences, select a provider, pay a bill etc..)
Partnership Integrations: Support the member experience in conjunction with relevant integrations through health plans and digital health partners
Reporting: Create scalable, accurate, differentiated internal and external reporting
Internal: Executive Dashboards/ KPI visualization
External: Client Reporting as a Product
Requirements
7+ years experience in Product Management
4+ years consumer product experience
Healthcare or HealthTech experience is ideal
Bachelors degree is required
Experience with start-up/growth phase company
Ability to travel up to 1-2x per quarter
Benefits
Medical Insurance
Dental Insurance
Vision Insurance
Short & Long Term Disability
Life Insurance
401k with company match
Paid Time Off
Paid Parental Leave
LOCATION: Remote | United States
Employer Direct Healthcare does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.
Employer Direct healthcare (EDH) is on a mission to transform access to excellent care for the moments that matter most. As the leading provider of surgical benefits for self-insured employers, we bring guided access to high-quality, affordable care for employers, their employees and the family members. We understand and have experienced the challenges of navigating specialized healthcare and we are dedicated to making a change.
EDH is the market leader for Independent Centers of Excellence (CoE). We have challenged the status quo in healthcare by bringing top quality surgeons within reach of all. Our surgeon-first model is the largest and most accessible network (3-4x larger than our peers), which has delivered an ROI 3x our peers. We serve hundreds of self-funded plan sponsors across 1000+ employers, representing over 4 million people across the U.S. We've saved our clients over $700 million since we were founded!
Ultimately, the US healthcare system at-large is flawed. Costs continue to rise while life expectancy stagnates. We are moving the needed on this problem by improving surgery outcomes - making people healthier - and lowering healthcare costs at the same time.
About You:
You have a drive and AMBITION to tackle big problems. Big problems require big ideas and a team that supports new ideas.
You CARE deeply for your customers. Your customers aren’t just the individuals using your product. They are the driving factor in your motivation to make a change.
You thrive in a TEAM ENVIRONMENT. Collaboration is key in innovation and creating change.
A DIVERSE environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives & you cherish the differences in each individual that you interact with.
You are DETAIL ORIENTED, but more so, focus on the execution of your content while balancing a fast-paced environment.
You understand that PROGRESS is critical to making change. You take the time to celebrate the small and big wins. Understanding that each improvement to a process helps move towards a greater change.
INTEGRITY guides you in life. Focusing on the truth versus just giving people the answers they want to hear.
If this sounds like you, we would love to connect to speak further about career opportunities at Employer Direct Healthcare.
Please apply to our role & someone from our HR Team will reach out to help you navigate our interview process.
Product Manager, TPA & Provider Solutions
The Product Manager, TPA and Provider Solutions is responsible for helping build and grow our end to end payor and provider products that increase referrals, protect and grow our provider network, and streamline administrative and financial processes. The role helps drive two charges: 1) build seamless and optimized front end provider experiences for providers and operational experiences for internal stakeholders, and 2) enable high quality data foundations that drive our member, provider, and client/partner operations. This role will help shape and evolve the product function towards better processes, tooling, and execution as we aim to continuously improve our craft.
Responsibilities:
Discovery: Perform deep discovery and user research with stakeholders, members, internal users, while taking into account legal, regulatory and competitive and market dynamics. Bring qualitative and quantitative insights to the table for discussion
Strategy: create and drive the Provider Experience product strategy coupling the front-end user/member experience with a world class care team service experience. Collaborate and align strategy with relevant stakeholders including presenting to and working with senior leadership.
Roadmap: create, align, and provide cross org visibility to TPA & Provider Solutions roadmap.
Alignment: create top down and bottoms-up alignment ensuring your direct, peers, teams, and senior leadership are providing the right level of guidance in accordance with RACI or similar.
Experimentation: Set the bar for when and where to experiment. Bring a data-driven approach to building product, but leverage your experience and product sense to deliver the right products on time and in budget. Perform rapid experimentation where needed, test manually, build stat sig experiments that prove and disprove our hypthoesis
Approach: Apply product led growth concepts, letting our users (internal/external) shape our Analyze existing products, make the tough calls, say no, and create pitches and actionable plans for implementing new features. Make smart decisions applying 1 vs. 2 way door framework
Process: Refine and build process as needed to ship high quality products on time and in budget while ensuring visibility and alignment across the org. Manage the product development process and timeline to ensure targets are met on time and in budget
Provider Experience:
Eligibility
Billing & claims
Data and systems: we ingest multiple data sources – eligibility, claims, prior authorization feeds to drive our systems. Through our growth we have been scrappy to win business as the opportunity allowed. Going forward we need to set specific standards and rules for the future to reduce operational overhead and increase simplicity in our service offering.
Internal tools and systems: we have a number of internal tools and systems that service different parts of the business for example identifying provider / facility targets, credentialing providers etc. These systems need to be refined and developed to increase the productivity of the owning business team
Data activations/insights: leverage key data and insights to keep members informed, engaged, and able to perform key tasks (e.g. provide preferences, select a provider, pay a bill etc..)
Partnership Integrations: Support the member experience in conjunction with relevant integrations through health plans and digital health partners
Reporting: Create scalable, accurate, differentiated internal and external reporting
Internal: Executive Dashboards/ KPI visualization
External: Client Reporting as a Product
Requirements
7+ years experience in Product Management
4+ years consumer product experience
Healthcare or HealthTech experience is ideal
Bachelors degree is required
Experience with start-up/growth phase company
Ability to travel up to 1-2x per quarter
Benefits
Medical Insurance
Dental Insurance
Vision Insurance
Short & Long Term Disability
Life Insurance
401k with company match
Paid Time Off
Paid Parental Leave
LOCATION: Remote | United States
Employer Direct Healthcare does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.