Job Summary

The Technical Product Manager (TPM) II serves as a strategic bridge between business stakeholders and solution delivery teams within a specific domain cluster that supports key functions and capabilities of the health plan. In this position, the TPM II owns a primary domain and is accountable for ensuring Information Technology (IT) solutions deliver measurable improvements in business outcomes and business value. This position ensures the successful delivery of digital and operational solutions aligned with the organization’s strategic goals.

The TPM II drives the creation of clear problem statements and desired outcomes from business needs, enabling technically ready requirements and informing actionable product strategy. This position supports the prioritization of product backlogs in partnership with business owners and participates in execution through Agile Systems Development Life Cycle (SDLC) processes.

The TPM II ensures all technical solutions within the domain align with enterprise reference architecture and governance standards, while maintaining compliance with healthcare payer and regulatory requirements, and collaborating with key stakeholders to achieve business intent and deliver measurable value.

This position supports Health Plan Operations by focusing on a specific domain cluster, such as Customer and Member Engagement, Health Services and Quality Oversight, Provider Network and Data Operations, or Finance, Claims, Human Resources, and Compliance Operations, and works across the related business functions within that cluster. The TPM II applies functional healthcare systems knowledge to ensure solutions meet business intent and regulatory requirements, leverages data to measure outcomes and validate hypotheses, and promotes disciplined product management practices within the domain. This position serves as a collaborative partner to technical teams and business stakeholders, ensuring solutions within the cluster deliver measurable business value and operational improvements.

Duties

Collaborates with stakeholders to define the product vision, solution intent, scope, and roadmap within the assigned domain cluster, ensuring initiatives are aligned with strategic objectives, measurable business outcomes, and consistent value delivery across related business functions.

Leads the creation of clear problem statements and desired outcomes from complex business needs within the domain cluster, enabling technically ready requirements for IT and development teams. Ensures requirements are accurate, complete, timely, and aligned with defined success metrics to support cluster-level product strategy.

Collaborates with business and IT stakeholders and to ensure solutions meet the business intent of the cluster and align with reference architecture and governance standards. Evaluates technical dependencies and trade-offs within the cluster and ensures requirements are technically ready.

Supports backlog prioritization with Business Owners for initiatives within the cluster, participates in sprint planning and review sessions, and facilitates alignment to support successful execution of cluster-level initiatives.

Participates in solution delivery activities to ensure alignment with business intent, success metrics, and regulatory requirements. Monitors product performance within the domain, identifies improvement opportunities, and leverages data and analytics to validate outcomes and inform enhancements.

Collaborates with IT and business partners to ensure solutions within the domain comply with Health Insurance Portability and Accountability Act (HIPAA), Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DHCS), and other relevant regulatory requirements.

Partners with business owners, leaders, and subject matter experts (SMEs) to ensure technology delivery aligns with domain initiatives. Leads facilitated cross-functional workshops within the domain to identify key problems, define solution approaches, and promote alignment across business and IT stakeholders.

Applies domain knowledge to identify opportunities that enhance the needs and goals of their assigned business verticals and raise those to relevant IT and business stakeholders.

Performs other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 6 years of experience in a health plan, payer organization and/or health system, ideally as a Technical Product Management or similar role that bridges the business and IT.

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 & Quality Oversight: care management, population health, behavioral health, pharmacy, UM authorizations, quality oversight, other health care delivery areas.

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 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.

Preferred:

Experience in a bridge role supporting IT and business in a Health Care Payer organization in a specific domain.

Experience facilitating and/or supporting 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.

Skills

Required:

Understanding of SDLC and agile delivery processes.

Ability to translate 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.

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

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

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.

Strong analytical and problem-solving skills.

Knowledge 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 applications).

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

Preferred:

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.

Skilled at developing visuals and documentation supporting technical product management practices.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Preferred:

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

Health Services Delivery & Quality Oversight Aligned to Wings of Care & Change

Enable clinical care: population health, care management, behavioral health, pharmacy. Member 360 enablement. UM authorizations & support. Support Community Resource Centers.

Care Advanced, *Optum Impact Pro *QNXT UM, *Onbase *EDIFECS Rules Engine for CMS, Cognizant Claimsphere, Cozeva, HDS, Inputs to Sales Force Member and Provider Portal, Future: mPulse, Nice CXOne

P Provider Network Operations & Data Aligned to Wings of Access

P Provider portal, Provider data management & network operations enablement, Prior Authorization Interoperability (PAI) submission workflows.

*Helix ,*Sales Force Provider Portal, *Future: Prior auth solution

Finance / Claims / + HR / Compliance Enablement Aligned to Wings of Excellence & Talent

Claims processing and payments, Payment integrity, Encounter processing, Billing and reporting.

*QNXT (Claims), *SAP (Finance & HRIS), Payspan, *Edifecs Pareo ,C360, Reporting Systems

Physical Requirements

Additional Information