Product Owner - Group Health

The Group Health Product Owner serves as the subject matter expert for Prime Health's Commercial Group Health solutions. Reporting to the Director of Product, this role is responsible for translating product priorities and business needs into clear, actionable work for Engineering and supporting the successful delivery of enhancements, features, and product improvements. This role requires expertise in Commercial Group Health claim processing, including the No Surprises Act, ERISA-related claim considerations, Qualifying Payment Amounts, claim scrubbing, large dollar negotiations, PPO network workflows, and out-of-network cost containment solutions.

What You'll Do

• Serve as the subject matter expert for Prime Health's Commercial Group Health product solutions
• Own product workflows related to Commercial Group Health claim processing, PPO network application, out-of-network solutions, claim scrubbing, and large dollar negotiations
• Maintain working knowledge of No Surprises Act requirements, ERISA-related claim considerations, Qualifying Payment Amounts, and related claim handling processes
• Translate product priorities, client needs, regulatory requirements, and operational workflows into user stories, acceptance criteria, and development-ready requirements
• Clarify requirements and provide day-to-day product decision support during active development cycles
• Partner with the Agile Delivery Manager, Product Analyst, QA, and Engineering to support delivery execution
• Confirm delivered functionality meets intended business outcomes, regulatory expectations, acceptance criteria, and user workflow needs
• Support user acceptance testing, test scenario review, business readiness confirmation, demos, and training
• Act as a product resource for Group Health product functionality, claim workflow, network application, out-of-network processes, and product capabilities
• Support Implementation and Client Services through product knowledge transfer, workflow clarification, and client-specific configuration support
• Identify new feature opportunities based on feedback from clients, prospects, Sales, Operations, Compliance, Legal, and internal stakeholders
• Evaluate enhancement requests to ensure the underlying business problem is understood before defining a solution

What We're Looking For

• Bachelor's degree in Business, Healthcare Administration, Information Systems, Product Management, or a related field preferred
• 5+ years of experience in a Product Owner, Product Analyst, Business Analyst, Operations, Claims, Network, or healthcare technology role
• Experience in Commercial Group Health, healthcare claims, PPO networks, out-of-network solutions, medical bill review, claim repricing, or cost containment strongly preferred
• Experience with No Surprises Act, ERISA, Qualifying Payment Amounts, claim scrubbing, large dollar negotiations, PPO network application, or out-of-network claim handling preferred

Competencies

• Strong understanding of Commercial Group Health claim processing workflows
• Working knowledge of No Surprises Act requirements, ERISA-related claim considerations, Qualifying Payment Amounts, claim scrubbing, and out-of-network claim workflows
• Strong understanding of PPO network workflows, provider network application, repricing logic, and out-of-network solutions
• Ability to translate complex healthcare, regulatory, claim, and operational requirements into clear product requirements and user stories
• Strong ability to write user stories, acceptance criteria, business rules, and functional requirements
• Experience working directly with cross-functional teams in an agile delivery environment
• Strong communication, collaboration, problem-solving, stakeholder management, and timely decision-making skills
• Familiarity with backlog management and delivery tools such as Azure DevOps, Jira, or similar platforms preferred

Why You'll Love Working at Prime Health Services

• Medical Insurance (high deductible plan with an HSA)
• Dental Insurance
• Vision Insurance
• Short-term and long-term disability paid by the company
• Group term life paid by the company
• Generous PTO
• Wellness program with monetary rewards
• Employee recognition programs with monetary rewards
• Corporate office amenities - specialty coffee machines, assorted tea options, smoothie bar, collaborative workspaces, fruit provide by company and an onsite market
• Regular employee events

About Prime Health Services

Prime Health Services (PHS) is a national medical cost containment company specializing in customized PPO network solutions. Since 2001, we've partnered with insurance carriers, TPAs, self-insured groups, and government entities to deliver high-quality healthcare access at discounted rates. Our technology driven approach allows us to provide fast, flexible, and dependable service to our clients while supporting a collaborative, employee-focused workplace.

PI5da43b2c5-