Product Owner - Post Adjudication Voucher (Remote)

Resp & Qualifications

PURPOSE:
Drives value to the business by building, managing, and maintaining a Product Backlog in collaboration with IT teams. Represents the business to the team and defines business purpose and value for them. Defines the details of what is to be done and the overall scope of the project for the product offering. Ensures that acceptance criteria are well-defined. Plays a key role in shaping the product direction, creating the feature(s), writing user stories, and innovating collaboratively through Joint Application Development (JAD) and other brainstorming sessions.

ESSENTIAL FUNCTIONS:

• Develops and aligns the Product Roadmap to strategic goals by working with customers, both internal and external, as well as Stakeholders to analyze and document both business and technology needs.
• Engages with the Agile development team in defining and maintaining Product Backlog epics and breaking them into features, user stories and acceptance criteria.
• Informs business decisions by drafting key objectives and results, strategies, and ensures appropriate levels of data is optimized by and through the product.
• Partners with product management and senior management to create, implement, and adjust the product to fit the company portfolio; represents the team while managing business with clients, users, and stakeholders.
• Communicates the business' product needs to technologists, internal and external business partners, and is held accountable for the functionality and the adoption of the created product.
• Articulates the value proposition to clients, internal and external business partners, and key stakeholders.
• Researches and analyzes product roadmap, market, and users.
• Helps advocate for and broaden team understanding of Agile methods, knowledge of new technologies and trends.

SUPERVISORY RESPONSIBILITY:
Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Product Management, Engineering, Information Technology or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Licenses/Certifications Preferred:

• Certified Scrum Product Owner

Experience:

• 4 years experience business analysis, business development, solutions development, system analysis, technical design/development implementation or equivalent experience OR
• 2 years product owner experience

Preferred Qualifications:

• Certified Scrum Product Owner - CSPO
• Previous healthcare experience
• Advanced degree

Knowledge, Skills and Abilities (KSAs)

• Proficient in Agile methodologies, principles, and procedures.
• Ability to define and build product roadmap.
• Ability to negotiate with all stakeholders
• Ability to manage stakeholders and their expectations.
• Ability to recognize, analyze, and solve a variety of problems.
• Proficient knowledge of Post Adjudication Voucher (PAV); EDI 835 & 837 transaction processes, including reconciliation, adjustments, and payment accuracy.
• Strong understanding of claims adjudication and post adjudication workflows, including error resolution and compliance requirements.
• Experience with claims processing systems and related reporting tools.
• Ability to analyze, interpret, and validate claim data for accuracy and completeness.
• Skilled in identifying and resolving discrepancies with voucher and payment records.
• Strong documentation skills for creating process guides and SOPs.
• Excellent communication skills, with the ability to explain technical processes to non-technical stakeholders.
• Ability to work collaboratively with cross-functional teams including finance, operations, and IT.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $79,776 - $158,444

Travel Requirements
Estimate Amount: 10% Domestic travel between CareFirst locations and client offices may be required.

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Systems Analysis

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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