Job Summary

The Technical Product Manager (TPM) III serves as a strategic bridge between business stakeholders and Information Technology (IT) teams across multiple business verticals that support key functions and capabilities of the health plan. In this position, the TPM III owns one or more primary domains while supporting other TPMs with cross-domain initiatives and is accountable for ensuring IT solutions deliver measurable improvements in business outcomes and enterprise value. This position manages the successful delivery of digital and operational solutions aligned with the organization’s enterprise strategy, drives tangible improvements in the business domain(s) they support, and guides the development and integration of product roadmap artifacts across multiple domains.

The TPM III drives the creation of clear problem statements and defines desired outcomes from complex business needs that enable technically ready requirements and inform actionable product strategy. In partnership with business owners, this position assists in prioritizing product backlogs and helps drive execution through Agile Systems Development Life Cycle (SDLC) processes.

The TPM III leads the delivery of enterprise technology solutions by ensuring alignment with enterprise architecture and governance standards while maintaining compliance with healthcare payer and regulatory requirements. This position collaborates closely with key stakeholders to translate strategic objectives into scalable solutions, evaluating technical trade-offs and dependencies to balance scope, complexity, and business value.

This position supports Health Plan Operations within one or more primary domains, including Health Services, Provider Operations, Customer Services, Finance, and Compliance, while contributing to alignment across intersecting capabilities. The TPM III drives the application of advanced healthcare systems knowledge, influencing strategic decisions, ensuring accountability for outcomes, and leveraging data to validate product hypotheses and measure results. This position promotes disciplined product management practices across the domain and provides expert guidance to technical teams to ensure solutions deliver business intent and enterprise value. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.

Duties

Leads business stakeholders in defining product vision, solution intent, scope, value hypothesis, and roadmap aligned with enterprise strategy and measurable business outcomes; ensures enterprise-wide impact and alignment across multiple business verticals and strategic objectives, while owning one or more domains and coordinating cross-domain roadmaps in collaboration with other TPMs.

Drives the translation of complex business needs into clear problem statements and outcomes that inform technically ready requirements for IT and development teams. Ensures requirements are accurate, complete, timely, and aligned with defined success metrics to support product strategy and enterprise delivery of business value.

Partners with internal teams ensure business requirements and product intent are clearly understood and proposed solutions align with enterprise reference architecture and governance standards. Provides guidance and oversight to ensure requirements are technically ready and aligned with product strategy and evaluates integration dependencies and trade-offs across systems.

Collaborates with key stakeholders to ensure the product backlog for the domain is effectively prioritized, supports other TPMs with cross-domain backlog coordination, and participates in sprint planning and review sessions to maintain strategic alignment.

Manages the delivery of quality and member-focused digital solutions. Ensures the business units understand the technology solution, overall solution delivery, and compliance with governance processes, architecture standards, as well as their roles and accountabilities in each phase of the delivery cycle. Provides oversight for testing, validation, and deployment activities to ensure solutions align with business intent, success metrics, and regulatory requirements, while advising teams on enterprise-level expectations.

Monitors product performance, identifies improvement opportunities, and drives continuous enhancement to ensure measurable value realization and cross-vertical alignment leveraging data and analytics to validate outcomes.

Ensures alignment with Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services (DHCS), Health Insurance Portability and Accountability Act (HIPAA), and other payer regulatory requirements.

Partners with business owners, business leaders, and subject matter experts (SMEs) to ensure technology delivery aligns with enterprise initiatives and cross-vertical priorities. Leads facilitated cross-functional workshops to identify key problems and define solution approaches and influence cross-functional alignment.

Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance and drives measurable outcomes. Consults across business operations, provides mentorship, contributes specialized knowledge, and recommends process improvements. Ensures that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training as needed.

Performs other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 10 years of experience in a health plan, payer organization and/or health system, ideally as a Technical Product Management or similar role.

Experience in at least one of the following healthcare domains:

Customer Engagement / Front Office Operations: enrollment and eligibility, call center, member/provider portals, member outreach, appeals and grievances, sales/marketing portals

Health Services Delivery and Quality Oversight: care management, population health, behavioral health, pharmacy, UM authorizations, quality oversight

Provider Network Operations / Data: provider portals, provider data management & network operations enablement, Prior Authorization Interoperability (PAI) submission workflows

Finance / Claims / HR / Compliance Enablement: claims processing & payments, payment integrity, encounter processing, billing/reporting, HR/compliance systems

Proven experience translating complex business needs into clear problem statements that enable technically ready requirements for IT and development teams.

Experience delivering enterprise digital solutions that improve member and provider experience, operational efficiency, and maintain regulatory compliance.

Experience with agile product management frameworks, backlog prioritization, sprint planning and related tools, including prior exposure to health plans or health system digital solutions.

Experience collaborating with cross-functional business and IT teams to drive enterprise solution delivery and ensure alignment with organizational priorities.

Experience facilitating interdepartmental workshops to define product strategies, uncover domain needs, and guide IT and business partners toward effective solutions.

Experience presenting key initiatives, product strategies, and roadmap updates to senior leadership, highlighting enterprise impact and strategic value.

Preferred:

Experience supporting operational or strategic initiatives across the Health Services Delivery and Quality Oversight domain in a payer organization, including care management, population health, behavioral health, pharmacy, UM authorizations, and quality oversight.

Skills

Required:

Advanced understanding of SDLC and agile delivery processes.

Ability to translate complex business needs into clear problem statements that define desired outcomes and goals. Ability to develop structured problem statements, workflows, documentation, and supporting artifacts that translate business and regulatory requirements into technically ready functional requirements for IT and development teams.

Ability to develop product roadmaps and other visuals that share how their domain’s capabilities and systems evolve and share that visual story with business owners and executive leadership to help move the outcomes of their business domain(s) forward.

Excellent communication, collaboration, and stakeholder management skills, with the ability to understand and communicate complex business requirements to a diverse group of key stakeholders and facilitate alignment between business and IT systems.

Expert in Jira, Confluence, or similar project management tools to manage requirements, backlogs, and solution delivery.

Advanced understanding of data models, system interfaces, APIs, and enterprise reference architecture with the ability to communicate integration concepts and solution dependencies effectively to both IT and business teams.

Excellent analytical and problem-solving skills.

High functional understanding of health plan and/or health system systems and applications, including core operational systems, upstream and downstream interfaces, workflows, and digital platforms (e.g., QNXT (Claims/Utilization Management (UM)), Salesforce Health Cloud, Care Advanced, or comparable healthcare application).

Excellent understanding of healthcare regulatory requirements including HIPAA, CMS, DHCS, and other payer frameworks.

Preferred:

Advanced ability to develop clear visuals and documentation supporting technical product management.

Familiarity with FHIR, APIs, cloud architecture, or other modern healthcare interoperability standards to align with industry best practice.

Expertise in enabling large-scale improvements and measurable outcomes across the domains.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Preferred:

Agile, SDLC, and regulatory compliance training for healthcare payer operations.

Physical Requirements

Additional Information