Product Manager - Healthcare EDI and Claims Processing

Product Manager (EDI Claims Processing)

Company : ComplexCare Solutions

Location : Remote or Hybrid (based on CCS policy)

Department : Technology

Reports To : VP, Technology

Position Summary

ComplexCare Solutions is seeking a seasoned Product Manager to lead the strategy, development, and optimization of our EDI claims processing capabilities. This role will focus on the full lifecycle of EDI transactions-particularly 837 (claims), 835 (remittance), and 277 (claim status)-with a strong emphasis on risk adjustment workflows and full-value claims submission. The Product Manager is responsible for establishing deep product expertise from a product and market perspective by understanding buyer and user personas, features and functionality, ROI, value proposition, architecture, competitive landscape, voice of customer, and market trends. This person has strong communication and influencing skills and collaborates with cross-functional stakeholders (i.e. development, marketing, sales, implementation, client success, legal / risk, finance) in efforts to support their product(s) in market. This person is responsible for understanding the jobs to be done and leverages market intelligence, regulatory shifts, client feedback, and internal stakeholder feedback to define and prioritize enhancements (features or operational tools) and new products into a product roadmap.

Key Responsibilities

• Own the product roadmap for EDI claims processing, including enhancements to 837, 835, and 277 transaction workflows.
• Collaborate with engineering, QA, and operations teams to automate and optimize claims generation, validation, and submission processes.
• Partner with internal stakeholders (e.g., Product & Services, Finance, CSO) to ensure alignment with business goals and compliance requirements.
• Lead vendor integration efforts (e.g., ComplexCare Solutions CMP) and manage relationships with clearinghouses and payers.
• Define and track KPIs such as claims submission success rate, adjudication turnaround time, and remittance reconciliation accuracy.
• Translate regulatory and payer-specific requirements into actionable product features and enhancements.
• Drive initiatives to support full-value claims for Medicaid, Medicare Advantage, and HIX programs, including CPOM entity alignment and state-specific configurations.

Required Qualifications

Preferred Skills

ComplexCare Solutions Offers a Competitive Salary and Benefits Package

In addition to the base compensation, this position may be eligible for performance-based incentives.

The actual base pay offered may vary depending on multiple factors including, but not limited to, job-related knowledge / skills, experience, business needs, geographical location, and internal equity. At ComplexCare Solutions, it is not typical for an individual to be hired at or near the top end of the range for their role, and compensation decisions are dependent upon the facts and circumstances of each position and candidate.

Base Compensation Range

$95,800 — $130,000 USD

Studies have shown that women and people of color are less likely to apply for jobs unless they believe they meet every one of the qualifications listed in a job description. If you don't meet every qualification listed but are excited about our mission and the work described, we encourage you to apply regardless. ComplexCare Solutions is most interested in finding the best candidate for the job and you may be just the right person for this or other roles.

By embracing diversity, equity and inclusion we enhance our work environment and drive business success. ComplexCare Solutions strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

ComplexCare Solutions is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirement.

The Company maintains a drug free work environment for all of its associates, which includes employees, contractors and vendors. It is unlawful for associates to manufacture, sell, distribute, dispense, possess or use any controlled substance or marijuana in the workplace and doing so will result in disciplinary action, up to and including termination of employment or the contracted relationship.

To review the legal requirements, including all labor law posters, please visit this link