Job Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
We are seeking an experienced Product Owner with deep expertise in healthcare claims and eligibility, specifically within Community and State (Medicaid) programs. The ideal candidate will drive the development, enhancement, and management of products that support claims processing, eligibility verification, and compliance for Medicaid populations. You will collaborate closely with business stakeholders, technical teams, and external partners to ensure our solutions meet regulatory requirements and deliver value to our members.
Designs, develops, and manages activities for a specific product or group of products from product definition and planning through production, release, and end of life. Responsible for the full product lifecycle management, with a technical focus, including strategy, design, development, management, and end of life of new, existing or acquisition products. Leverage market insights to understand market/customer needs as well as emerging technology developments and trends to identify new opportunities or make adjustments to current product offerings. Balances deep subject matter expertise in the product, business use cases and solid technical aptitude. Accountable for delivering product performance against expectations and updates changes to a product portfolio to improve competitive position, and optimal product performance to meet customer and market needs. Accountable to and/or own the P&L. Responsible for cross-functional stakeholder management to include but not limited to design, engineering, scrum teams, business leaders, etc., functioning as technical expert with a fluency in development concepts and modern development practices. Positions in this function may require a background or degree in computer science or engineering.
Primary Responsibilities:

• Serve as the subject matter expert for healthcare claims adjudication, eligibility determination, and enrollment processes in Community & State (Medicaid) environments
• Own the product backlog: define features, user stories, acceptance criteria, and prioritize work based on business value
• Collaborate with business stakeholders (operations, compliance, clinical teams) to gather requirements and translate them into actionable product enhancements
• Work closely with engineering teams during sprint planning and execution to ensure solutions align with business goals
• Monitor changes in Medicaid regulations at both state and federal levels; proactively adjust product strategy to maintain compliance
• Analyze data on claims performance, member eligibility trends, system defects/issues; recommend process improvements or new features based on findings
• Lead user acceptance testing (UAT), ensuring deliverables meet quality standards and stakeholder expectations
• Communicate product roadmap updates to internal teams; provide training or documentation as needed for new features or process changes
• Analyzes and investigates
• Provides explanations and interpretations within area of expertise
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Bachelor's degree in Healthcare Administration, Information Technology, Business or related field (Master's preferred)
• 5+ years of experience as a Product Owner/Manager or Business Analyst within health insurance/managed care - specifically Medicaid/Community & State populations
• Experience working in Agile/Scrum environments
• Solid knowledge of healthcare claims processing workflows (837/835 transactions), EDI standards, eligibility verification protocols (270/271), and related regulatory requirements
• Familiarity with CMS guidelines for Medicaid programs
• Demonstrated ability to write clear user stories/use cases for technical delivery teams
• Demonstrated excellent communication skills - able to bridge gaps between technical/nontechnical audiences

Preferred Qualifications:

• Certified Scrum Product Owner (CSPO) or similar Agile certification
• Experience working directly with state agencies
• Prior work supporting multiple state Medicaid plans

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.