Note: The job is a remote job and is open to candidates in USA. SCAN is a nonprofit health organization dedicated to improving care for older adults. The Product Manager for QNXT Implementation is responsible for designing business requirements and workflows for the Claims workstream, collaborating with program managers and stakeholders to ensure the implementation aligns with enterprise goals.
Responsibilities
- Lead the design of future state business requirements, workflows, and operational processes for the Claims workstream within the QNXT implementation, ensuring alignment to business objectives, system capabilities, and enterprise transformation goals. Define and document end-to-end future state workflows for claims processing, adjudication, pricing, exception handling, and related operational activities, with clear traceability to business requirements, decisions, and downstream implementation needs
- Partner with program managers supporting Claims, Provider Data, and Configuration, including provider contracts, benefits, UM/business rules, and capitation, to ensure future state design decisions support an integrated end-to-end claims solution
- Facilitate workshops and working sessions with SMEs, product owners, operational leaders, and technical partners to elicit requirements, challenge assumptions, evaluate options, and drive sound future state design decisions
- Coach SMEs and product owners to think beyond current state processes and legacy system constraints, promoting best-practice design principles and ensuring the future state reflects the most effective and efficient operating model possible
- Serve as a key design authority for the Claims workstream by identifying process improvement opportunities, resolving design tradeoffs, surfacing risks and dependencies, and driving decisions that optimize system performance, usability, and operational outcomes
- Translate future state workflows and requirements into clear design artifacts and implementation inputs that support configuration, test scenario development, training, operational readiness, and go-live preparation
- Work closely with the program lead and other cross-functional stakeholders to maintain alignment on scope, priorities, dependencies, and decisions impacting the future state design of claims-related capabilities
- Ensure future state design deliverables are complete, high quality, and actionable, including requirements, workflow documentation, decision logs, process maps, design principles, and supporting materials for implementation teams
- Hold accountability for the overall quality and effectiveness of the Claims future state design, ensuring the solution enables efficient operations, supports business readiness, and establishes a scalable foundation for long-term success in QNXT
- We seek Rebels who are curious about AI and its power to transform how we operate and serve our members
- Actively support the achievement of SCAN’s Vision and Goals
- Other duties as assigned
Skills
- Bachelor's degree or equivalent combination of education and experience in Business, Health Administration, Information Systems, or related fields
- Minimum 6 years related experience as a Product Manager with in the health plan, healthcare, or related industry
- Strong knowledge of healthcare payer claims operations, including end-to-end claims workflows, adjudication logic, pricing, payment, exception handling, and operational dependencies
- Demonstrated ability to design future state requirements, workflows, and business processes for complex system implementations or operating model transformations
- Working knowledge of QNXT or similar core administrative platforms and the interaction between claims and related domains such as provider data, provider contracts, benefits, UM/business rules, and capitation
- Ability to facilitate cross-functional workshops, synthesize input from multiple stakeholders, and translate business needs into clear, actionable requirements and workflow documentation
- Strong coaching and influencing skills, with the ability to guide SMEs and product owners beyond current state thinking and toward efficient, scalable, and sustainable future state solutions
- Ability to identify design tradeoffs, process inefficiencies, and cross-workstream dependencies, and recommend solutions that optimize end-to-end business and system performance
- Strong analytical, organizational, and documentation skills, including the ability to maintain requirements, process maps, decisions, and design artifacts with a high degree of quality and traceability
- Excellent verbal and written communication skills, with the ability to present complex design concepts, recommendations, and decisions clearly to leadership, operational teams, and technical stakeholders
- Ability to support downstream implementation activities by ensuring future state designs are practical, testable, configurable, and aligned to operational readiness and go-live needs
- Strong accountability and results orientation, with commitment to ensuring the Claims future state design delivers an effective, efficient, and scalable foundation for QNXT implementation success
- Future state design, product management leadership experience
- Systems thinking and end-to-end process optimization
- Requirements elicitation and workflow design
- Facilitation, influence, and stakeholder alignment
- Coaching and challenging current state thinking
- Analytical problem solving and decision making
- Change leadership and continuous improvement mindset
- Cross-functional collaboration and partnership
- Accountability for design quality and business outcomes
- Advanced Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, Access), Visio, and SQL required
- Master's degree (preferred) - MBA, MPH, MS in Health Administration, Information Systems, or related field
Benefits
- Medical Benefits
- Paid Sick Time
- Excellent 401(k) Retirement Saving Plan
- Robust employee recognition program
- An opportunity to become part of a team that makes a difference to our members and our community every day!
Company Overview
About SCAN Keeping Seniors Healthy and Independent–that’s been our mission for more than 40 years. It was founded in 1977, and is headquartered in Long Beach, California, USA, with a workforce of 1001-5000 employees. Its website is https://www.thescangroup.org/.