Senior Product Manager, Healthcare Payer Strategy at Oracle

Job description

We are seeking a Product Manager to drive the expansion of Oracle's healthcare claims adjudication platform for the United States market. Our existing platform supports healthcare claims processing across multiple international markets. This role will focus on defining and delivering the capabilities required to meet the unique business, operational, and regulatory requirements of the U.S. healthcare system. Acting as the product owner for U.S.-specific adjudication functionality, you will work closely with health plans, healthcare organizations, implementation teams, and internal stakeholders to understand market needs and translate them into product requirements that guide development. A key responsibility of this role is enabling engineering teams to successfully build and deliver U.S. healthcare claims adjudication capabilities. You will engage directly with customers to demonstrate our solution, understand their claims processing workflows, gather requirements, document business rules, and define functional specifications that support product development. You will serve as the bridge between customers, healthcare domain experts, and engineering teams, ensuring that delivered capabilities align with market expectations and operational realities. The successful candidate will possess deep knowledge of the U.S. healthcare industry and fee-for-service claims adjudication processes, including claims intake, benefit determination, pricing, reimbursement methodologies, edits, payment calculation, and claims lifecycle management. They will leverage this expertise to help shape product strategy, prioritize roadmap investments, and ensure our platform can effectively support the needs of U.S. healthcare payers. This is an opportunity to play a key role in bringing a proven global healthcare platform to the U.S. market and helping healthcare organizations modernize claims operations through innovative, scalable, and configurable technology. U.S. citizenship is required for this position, as the successful candidate will be required to obtain and maintain a U.S. government security clearance after hire. Required Qualifications • Deep knowledge of the U.S. healthcare industry and fee-for-service claims adjudication processes. • Experience with healthcare payer operations, claims administration, claims adjudication systems, payment integrity, reimbursement, or related healthcare technology solutions. • Experience in product management, business analysis, healthcare consulting, payer operations, or a related role. • Proven ability to gather, document, and prioritize complex business and functional requirements. • Strong customer-facing, presentation, and stakeholder management skills. • Experience working directly with healthcare payers, health plans, third-party administrators, or healthcare technology vendors. • Ability to translate complex claims processing requirements into software capabilities and functional solution designs. Preferred Qualifications • Experience with commercial, Medicare, Medicaid, or government healthcare programs. • Familiarity with healthcare claims standards and transactions, including X12 claims processing and related industry standards. • Knowledge of value-based payment models and reimbursement methodologies, including Accountable Care Organizations (ACOs), bundled payments, shared savings arrangements, pay-for-performance programs, capitation, and other alternative payment models. • Experience working in Agile software development environments. • Knowledge of modern claims platforms, payment integrity solutions, utilization management systems, care management platforms, or core administration systems. • Proven ability to use AI technologies to improve productivity, enhance decision-making, synthesize complex information, identify product opportunities, and strengthen collaboration across customers, product teams, and engineering organizations. • Strong interest in emerging AI capabilities and a track record of evaluating and applying AI-driven approaches to solve business problems, improve operational efficiency, and drive innovation within healthcare technology environments. • Serve as the product domain expert for U.S. healthcare claims adjudication capabilities. • Engage with prospective and existing customers to demonstrate product functionality and communicate the value of Oracle's claims adjudication platform. • Conduct customer workshops, discovery sessions, and requirements-gathering activities to understand claims processing workflows, business rules, and operational challenges. • Translate customer needs into product requirements, user stories, functional specifications, and other product management artifacts. • Collaborate closely with engineering teams to define solution designs and clarify business requirements throughout the development lifecycle. • Support development teams by providing healthcare claims adjudication expertise and validating proposed solutions. • Analyze market requirements and identify product enhancements needed to support U.S. healthcare payer operations. • Contribute to product roadmap planning and prioritization for U.S.-specific capabilities. • Partner with implementation, consulting, sales, and customer success teams to support customer adoption and successful deployments. • Monitor industry trends, reimbursement models, and regulatory developments that may impact claims adjudication processes and product requirements. • Act as a trusted advisor to internal stakeholders on U.S. healthcare claims processing and adjudication practices. Disclaimer: Certain U.S. based or U.S. customer or client-facing roles may be required to comply with applicable requirements, such as immunization/occupational health mandates, and/or drug testing requirements. Range and benefit information provided in this posting are specific to the stated locations only US: Hiring Range in USD from: $91,400 to $187,000 per annum. May be eligible for bonus and equity. Oracle maintains broad salary ranges for its roles in order to account for variations in knowledge, skills, experience, market conditions and locations, as well as reflect Oracle's differing products, industries and lines of business. Candidates are typically placed into the range based on the preceding factors as well as internal peer equity. Oracle US offers a comprehensive benefits package which includes the following: 1. Medical, dental, and vision insurance, including expert medical opinion 2. Short term disability and long term disability 3. Life insurance and AD&D 4. Supplemental life insurance (Employee/Spouse/Child) 5. Health care and dependent care Flexible Spending Accounts 6. Pre-tax commuter and parking benefits 7. 401(k) Savings and Investment Plan with company match 8. Paid time off: Flexible Vacation is provided to all eligible employees assigned to a salaried (non-overtime eligible) position. Accrued Vacation is provided to all other employees eligible for vacation benefits. For employees working at least 35 hours per week, the vacation accrual rate is 13 days annually for the first three years of employment and 18 days annually for subsequent years of employment. Vacation accrual is prorated for employees working between 20 and 34 hours per week. Employees working fewer than 20 hours per week are not eligible for vacation. 9. 11 paid holidays 10. Paid sick leave: 72 hours of paid sick leave upon date of hire. Refreshes each calendar year. Unused balance will carry over each year up to a maximum cap of 112 hours. 11. Paid parental leave 12. Adoption assistance 13. Employee Stock Purchase Plan 14. Financial planning and group legal 15. Voluntary benefits including auto, homeowner and pet insurance The role will generally accept applications for at least three calendar days from the posting date or as long as the job remains posted. Career Level - IC3 Help shape the future of healthcare claims processing in the United States. Join our product team to extend Oracle's next-generation claims adjudication platform for the U.S. market by working directly with health plans and healthcare organizations to define the capabilities needed to support complex fee-for-service claims processing and payment operations.

Requirements

Must-haves

We are seeking a Product Manager to drive the expansion of Oracle's healthcare claims adjudication platform for the United States market.
U.S. citizenship is required for this position, as the successful candidate will be required to obtain and maintain a U.S. government security clearance after hire.
Deep knowledge of the U.S. healthcare industry and fee-for-service claims adjudication processes.
Experience with healthcare payer operations, claims administration, claims adjudication systems, payment integrity, reimbursement, or related healthcare technology solutions.
Experience in product management, business analysis, healthcare consulting, payer operations, or a related role.
Proven ability to gather, document, and prioritize complex business and functional requirements.
Strong customer-facing, presentation, and stakeholder management skills.
Experience working directly with healthcare payers, health plans, third-party administrators, or healthcare technology vendors.
Ability to translate complex claims processing requirements into software capabilities and functional solution designs.

Nice-to-haves

Experience with commercial, Medicare, Medicaid, or government healthcare programs.
Familiarity with healthcare claims standards and transactions, including X12 claims processing and related industry standards.
Experience working in Agile software development environments.
Knowledge of modern claims platforms, payment integrity solutions, utilization management systems, care management platforms, or core administration systems.
Serve as the product domain expert for U.S. healthcare claims adjudication capabilities.
Engage with prospective and existing customers to demonstrate product functionality and communicate the value of Oracle's claims adjudication platform.
Conduct customer workshops, discovery sessions, and requirements-gathering activities to understand claims processing workflows, business rules, and operational challenges.
Translate customer needs into product requirements, user stories, functional specifications, and other product management artifacts.
Collaborate closely with engineering teams to define solution designs and clarify business requirements throughout the development lifecycle.
Support development teams by providing healthcare claims adjudication expertise and validating proposed solutions.
Analyze market requirements and identify product enhancements needed to support U.S. healthcare payer operations.
Contribute to product roadmap planning and prioritization for U.S.-specific capabilities.

Application prep

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Keywords to mirror

agileai

Platform: oracle-cloud
Effort: medium

Benefits

Benefits detected in the listing.

Dental

Vision

401(K)

Paid Time Off

Parental Leave