Product Owner (Claims)

Job Description

Job Description

Description:

  Who We Are:

TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an innovative suite of specialty care management services and technologies that enable health plans and employers to improve the safety, quality, and affordability of healthcare. Through its platform and specialized team of clinical experts, TurningPoint works collaboratively with providers to deliver optimal care. TurningPoint offers condition-specific, quality-driven, value-based care management services that optimize care from diagnosis and discovery through recovery. TurningPoint’s comprehensive and integrated suite of services enhances the support individuals need, at the time they need it most. Since launching in 2015, TurningPoint has provided support to more than 50 million people nationwide across numerous clinical specialties including musculoskeletal, pain management, cardiology, wound care, ear/nose/throat, and sleep. TurningPoint’s model moves beyond denial-based care to holistic condition management that improves outcomes and reduces cost. TurningPoint is an independent organization, not owned or affiliated with a health plan or provider system.

Position Summary:
Responsible for serving as a key liaison between Operations and Technology, translating business and operational needs into clear system requirements and user stories, supporting prioritization of development work, and coordinating user acceptance testing to ensure technology solutions meet business needs.
A strong working knowledge of healthcare claims and claims processing is essential to success in this role. The individual must understand the healthcare claims lifecycle and be able to apply that knowledge when evaluating business requirements, identifying system impacts, developing user stories, supporting testing, and troubleshooting issues. The ability to understand how technology and system changes may impact claims processing, workflows, payment outcomes, and downstream operations is a critical component of the position.
This position requires a self-starter with a passion for technology, strong healthcare industry knowledge, and the ability to translate complex operational needs into actionable technology requirements. The successful candidate must be comfortable working in a fast-paced, dynamic environment and balancing multiple competing priorities. 

Roles and Responsibilities:

• Serve as a liaison between Operations, Technology, and other key stakeholders to translate business needs into clear functional requirements and user stories.
• Apply healthcare claims knowledge and experience to assess requirements, workflows, system functionality, defects, and proposed technology solutions.
• Manage healthcare claims processing workflows and identify potential upstream and downstream impacts associated with system or process changes.
• Writing, refining, and maintaining user stories, acceptance criteria, and business requirements.
• Partner with operational stakeholders to gather, clarify, and document business and system requirements.
• Manage and prioritize product backlog items based on business needs, operational impact, dependencies, and organizational priorities.
• Coordinate and support User Acceptance Testing (UAT) to validate that technology solutions meet documented business and operational requirements.
• Develop and/or review test scenarios and test cases, with particular attention to claims processing, claims outcomes, business rules, and end-to-end workflow impacts.
• Execute test cases and document results, defects, and required remediation.
• Investigate system and operational issues and clearly communicate findings between Operations and Technology to facilitate timely resolution.
• Evaluate defects and system issues to determine potential impact to claims processing and related business operations.
• Facilitate communication among business stakeholders, developers, testers, and other cross-functional partners.
• Support Agile/SCRUM processes, including backlog refinement, sprint planning, prioritization, and other team activities as appropriate.
• Provide application and production support as needed

Additional Responsibilities may include:

• Management of SCRUM team(s) as needed
• Writing test cases
• Executing test cases
• Providing application support
• Experience with software development and testing is a plus

Requirements:

  Education, Experience and Licensure:

• Bachelor's degree in a related field preferred, or an equivalent combination of education and relevant professional experience.
• Six (6)+ years of experience in healthcare technology, healthcare claims operations, healthcare systems, or a closely related field.
• Direct experience working with healthcare claims, claims systems, claims processing, or technology supporting claims operations is required.
• Experience working at the intersection of healthcare Operations and Technology is strongly preferred.
• A working understanding of healthcare claims processing and the claims lifecycle.
• Ability to evaluate claims-related workflows, business rules, system functionality, and operational impacts.
• Strong experience working with healthcare technology and healthcare-related systems.
• Experience creating user stories, documenting business requirements, and translating operational requirements into technology solutions.
• Experience managing and prioritizing a product or development backlog.
• Experience with User Acceptance Testing, quality assurance, test-case development, and defect management.
• Working knowledge of SCRUM/Agile processes; certification is not required.
• Strong analytical and problem-solving skills.
• Excellent written and verbal communication skills.
• Demonstrated ability to communicate complex issues between technical and non-technical audiences.
• Ability to identify issues, assess business impact, and work collaboratively across teams to drive resolution.
• Ability to manage multiple priorities and work effectively in a fast-paced environment.
• Experience with software development and/or software testing environments is preferred.

Tools and Technologies: (not required but preferred):

• Atlassian Suite of tool: Jira, Confluence
• Zendesk Tracking Software
• Other healthcare claims, workflow, testing, or application-support platforms

TurningPoint Healthcare Solutions is an Equal Opportunity Employer.