Senior Product Manager - Medicare Claims Systems SME

Job Description

Tria is seeking a Senior Product Manager and Medicare Claims Systems SME to support the Centers for Medicare & Medicaid Services (CMS) system that maintains Medicare beneficiary entitlement and utilization data and validates fee-for-service claims.

The Senior Product Manager translates CMS business and regulatory requirements into clear product requirements and user stories, manages the product backlog with the Product Owner and CMS stakeholders, and guides an Agile team to deliver Change Requests and problem fixes within CMS's established release calendar.

This role sits on a collaborative, Agile team maintaining a mission-critical Medicare claims processing system. This is a remote position, and all remote work must be performed in the United States.

Basic Requirements

• Ability to obtain a U.S. Federal Position of Trust clearance.
• Must reside in and perform work in the United States and must have lived in the United States for three of the last five years.
• Bachelor's degree.
• 10+ years of combined experience across healthcare IT, Medicare or Medicaid programs, or CMS regulatory compliance.
• 5+ years as a product owner, product manager, or business analyst in Agile software delivery, working with sprint teams and tools such as Jira and Confluence to capture requirements and develop business process models.
• 3+ years with direct experience in Medicare or Medicaid claims processing or CMS shared systems.

Additional Qualifications

• Certified in a product owner or product manager Agile credential (for example SAFe POPM, CSPO, or PSPO) and experience operating within the Scaled Agile Framework (SAFe), including PI Planning.
• Experience translating complex federal regulations and CMS business requirements into user stories with clear acceptance criteria.
• Ability to analyze business processes, evaluate system and downstream impacts, identify gaps, and recommend improvements.
• Strong oral and written communication, with the ability to document complex problems simply and clearly.
• Experience developing Change Requests and working within change control processes.
• Experience interpreting CMS guidance and HPMS memoranda and translating complex Medicare regulations into operational requirements, policies, and procedures.
• Familiarity with CMS shared systems and Medicare claims processing environments, including mainframe-based systems, is a plus.

Responsibilities

• Maintain the product backlog with the Product Owner, the COR, and end users, capturing CMS requirements as user stories with robust acceptance criteria.
• Maintain and enhance the product roadmap and collaborate with CMS on prioritization and capacity planning.
• Work with the Agile team through backlog refinement, sprint planning, and PI Planning to align development and testing with CMS business needs and the release calendar.
• Become an expert in CMS regulations, policies, and the CWF system, and conduct policy and program analysis to develop and adapt business requirements.
• Evaluate system and downstream impacts of Change Requests, provide high-level business requirements, and support estimation.
• Work with the sprint team to implement and accept user stories, validate completed work against the definition of done, and support release readiness.
• Develop Change Requests and supporting Agile documentation and oversee related quality assurance activities.
• Proactively surface risks, dependencies, and competing priorities, coordinating with stakeholders to support quality and timely delivery.

Public Trust Clearance

A minimum of 3 years of stay in the U.S. within the last 5 years is required to be eligible to qualify for public trust clearance sponsorship.

Work Location

Headquartered in Arlington, VA, we also have a primary office in Baltimore, MD for those who prefer to work on-site. Thie role requires the employee to be available to go to our Woodlawn MD office twice a week. However, with employees spread across 40+ states, we have many remote roles.

Why Tria?

What defines the Tria brand is more than just our dedication to excellence in our craft; it’s our incredible team of dedicated, talented, and passionate people that make Tria so exceptional. As people powering possible, we are all partners in our team’s shared success. As a company that cares about people, we seek to cultivate a culture in which all can thrive personally and professionally. We offer a top-tier benefits package to invest in your physical, mental, and financial health and wellness so that you can be your best self - at work and in life.

California Consumer Privacy Act (CCPA)

We are committed to protecting your privacy. As part of our compliance with the California Consumer Privacy Act (CCPA), we want to inform you about how we collect, use, and protect your personal information during the job application process. For more details, please review https://www.oag.ca.gov/privacy/ccpa.