Senior Product Manager - Health Plan Data & AI Products

Role Description

Healthcare quality is complex. Medisolv helps make it manageable—and actionable. We partner with hospitals, health systems, ACOs, and payers to bring clarity to quality data, connecting clinical and claims information into a single, reliable view. More than 1,800 organizations and 130M+ patient records rely on Medisolv to measure, report, and improve performance across 500+ measures tied to CMS, The Joint Commission, and other programs. With support from Bessemer Venture Partners Forge, we’re continuing to grow our platform and expand our impact—investing in advanced analytics, AI, and new capabilities that help healthcare organizations stay ahead of change and improve outcomes with confidence. If you know the health insurance and VBC worlds inside out, understand the math behind CMS quality calculations, and you're genuinely excited about putting autonomous AI agents to work on messy healthcare data, we want you on the team.

Performance Objectives

• First 30 Days – Foundation & Alignment
  • Build a deep understanding of Medisolv’s data ecosystem and CMS measure logic (HEDIS, Pharmacy, CAHPS/HOS).
  • Align with engineering, AI, and clinical stakeholders on priorities and high-impact use cases.
  • Define initial AI agent architecture and guiding principles for HITL safety and compliance.
• First 3 Months – Design & Prototype
  • Design and prototype AI agents to identify care gaps and predict Star Rating risks.
  • Stand up the foundation of the payer data core from fragmented datasets.
  • Develop initial CMS measure calculation engines and pilot action-oriented workflows.
• First 6 Months – Launch & Scale
  • Deploy production-ready AI agents that connect insights directly to gap-closing actions.
  • Expand and stabilize the payer data core and measurement automation.
  • Implement orchestrated workflows and mature HITL guardrails.
• First 12 Months – Optimize & Drive Outcomes
  • Optimize AI performance with feedback loops and expand to more advanced use cases.
  • Mature the data platform into a scalable, real-time decisioning engine.
  • Drive measurable improvements in Star Ratings and value-based care outcomes.

Qualifications

• Payer & VBC Domain Fluency: 5+ years of product management experience handling health plan data and VBC provider quality metrics.
• CMS Quality & Star Ratings Expertise: Knowledge of CMS calculations for MA Star Ratings, cut points, and triple-weighted measures.
• Deep Comfort with Core Payer Data: Hands-on experience with claims, eligibility, and enrollment datasets.
• A "Beyond-the-Dashboard" Mindset: Desire to build proactive software that adapts and automates workflows.
• AI & Data Literacy: Understanding of GenAI architectures, RAG, and agentic frameworks.
• Trust & Security First: Knowledge of HIPAA/HITRUST guidelines and ensuring AI outputs are accurate and explainable.
• Doer: Initiative-driven with a strong bias for action.
• Collaborative: Empathy for colleagues and ability to influence cross-functional collaboration.
• Flexibility: Open-minded and adaptable to changing environments.
• Growth Mindset: Intellectually curious with a passion for self-improvement.
• Resilient: Embraces change and maintains optimism.

Values

• Customer Success Obsession
• All-Star Team Collaboration
• Continuous Improvement through Curiosity & Data-Driven Learning
• Courage with Kindness
• Execution Focus: We Do Business, Not Just Talk Business

Company Description

Medisolv is committed to creating a diverse and inclusive workplace. We believe that diversity drives innovation, and we are dedicated to fostering an environment where all employees feel valued and respected.

Candidates must successfully complete a pre-employment background check and be legally authorized to work in the United States, as sponsorship is not available.