Senior Product Manager, Healthcare Payer Strategy
Oracle · United States
We are seeking a Product Manager to drive the expansion of Oracle's healthcare claims adjudication platform for the United States market.
Our existing platform supports healthcare claims processing across multiple international markets. This role will focus on defining and delivering the capabilities required to meet the unique business, operational, and regulatory requirements of the U.S. healthcare system. Acting as the product owner for U.S.-specific adjudication functionality, you will work closely with health plans, healthcare organizations, implementation teams, and internal stakeholders to understand market needs and translate them into product requirements that guide development.
A key responsibility of this role is enabling engineering teams to successfully build and deliver U.S. healthcare claims adjudication capabilities. You will engage directly with customers to demonstrate our solution, understand their claims processing workflows, gather requirements, document business rules, and define functional specifications that support product development. You will serve as the bridge between customers, healthcare domain experts, and engineering teams, ensuring that delivered capabilities align with market expectations and operational realities.
The successful candidate will possess deep knowledge of the U.S. healthcare industry and fee-for-service claims adjudication processes, including claims intake, benefit determination, pricing, reimbursement methodologies, edits, payment calculation, and claims lifecycle management. They will leverage this expertise to help shape product strategy, prioritize roadmap investments, and ensure our platform can effectively support the needs of U.S. healthcare payers.
This is an opportunity to play a key role in bringing a proven global healthcare platform to the U.S. market and helping healthcare organizations modernize claims operations through innovative, scalable, and configurable technology.
U.S. citizenship is required for this position, as the successful candidate will be required to obtain and maintain a U.S. government security clearance after hire.
Required Qualifications
- Deep knowledge of the U.S. healthcare industry and fee-for-service claims adjudication processes.
- Experience with healthcare payer operations, claims administration, claims adjudication systems, payment integrity, reimbursement, or related healthcare technology solutions.
- Experience in product management, business analysis, healthcare consulting, payer operations, or a related role.
- Proven ability to gather, document, and prioritize complex business and functional requirements.
- Strong customer-facing, presentation, and stakeholder management skills.
- Experience working directly with healthcare payers, health plans, third-party administrators, or healthcare technology vendors.
- Ability to translate complex claims processing requirements into software capabilities and functional solution designs.
Preferred Qualifications
- Experience with commercial, Medicare, Medicaid, or government healthcare programs.
- Familiarity with healthcare claims standards and transactions, including X12 claims processing and related industry standards.
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Knowledge of value-based payment models and reimbursement methodologies, including Accountable Care Organizations (ACOs), bundled payments, shared savings arrangements, pay-for-performance programs, capitation, and other alternative payment models.
- Experience working in Agile software development environments.
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Knowledge of modern claims platforms, payment integrity solutions, utilization management systems, care management platforms, or core administration systems.
- Proven ability to use AI technologies to improve productivity, enhance decision-making, synthesize complex information, identify product opportunities, and strengthen collaboration across customers, product teams, and engineering organizations.
- Strong interest in emerging AI capabilities and a track record of evaluating and applying AI-driven approaches to solve business problems, improve operational efficiency, and drive innovation within healthcare technology environments.
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Help shape the future of healthcare claims processing in the United States. Join our product team to extend Oracle's next-generation claims adjudication platform for the U.S. market by working directly with health plans and healthcare organizations to define the capabilities needed to support complex fee-for-service claims processing and payment operations.