CMS EDGE Server Product Manager / Principal / Architect

Key Responsibilities

• Serve as SME for CMS EDGE Server, ACA Risk Adjustment, and Reinsurance programs.
• Lead CMS EDGE Server implementations, enhancements, and operational support initiatives.
• Ensure accurate and compliant submission of membership, claims, encounter, and supplemental data to CMS.
• Drive data validation, reconciliation, and reporting quality improvements.
• Partner with business, operational, compliance, and technical teams to resolve data and reporting issues.
• Translate business requirements into product, process, and technical solutions.
• Provide strategic advisory support to health plan clients on CMS reporting best practices.

Required Qualifications

• 7+ years of healthcare payer experience.
• Deep expertise with CMS EDGE Server and ACA Risk Adjustment.
• Strong understanding of Reinsurance, Risk Adjustment, and regulatory reporting requirements.
• Experience with health plan membership, claims, and encounter data.
• Prominent implementation and client-facing consulting experience.
• Strong knowledge of payer operations and data quality processes.
• Excellent communication and stakeholder management skills.

Preferred Qualifications

• Experience with Facets (TriZetto).
• Medicare and Medicaid experience.
• Experience with Cognizant CMS EDGE Server and ClaimSphere.
• Knowledge of HEDIS, CMS STARs, and quality reporting programs.
• SQL, analytics, or healthcare data management experience.