Principal Product Manager, Claims and Encounters

Job Title: Principal Product Manager Claims and Encounters 

Location: Remote (Working hours are Monday-Friday PST)
Division: Medical Enterprise System Modernization Division (MESMD), Behavioral Health Transformation Project (BHT)
Department: California Department of Health Care Services (DHCS) 

Must work on shore in the US. We cannot sponsor or transfer an H1B Visa for this role.

Statement for Speridian Technology

Speridian Technology is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Reasonable accommodations are available for qualified individuals with disabilities during the application process.

• Translate the strategic requirements for BHT operational systems into an executable roadmap aligned to statutory deadlines. 

• Own roadmap prioritization, epics, and user stories and ensure adherence to all technical delivery standards.  

• Work directly with operations and data policy teams to transform state and federal financial and accountability reporting obligations into clear, implementable product requirements. 

• Own the modernization and user experience of external-facing claims and encounters management software enabling submission, validation, reconciliation, transparency, accountability and compliance. 

• Design user workflows that improve data quality at the source and give counties, providers, managed care plans, and DHCS visibility into submission status, data quality, state and federal compliance. 

• Coordinate and drive the development of enterprise business process maps, data models, and technical architecture with policy, data, and engineering partners.  

• Ensure claims and encounter systems integrate seamlessly with Medical Enterprise Systems. 

• Define measurable outcomes tied to compliance, timeliness, reconciliation accuracy, and operational performance 

• 10+ years of product management experience in healthcare technology 

• Direct ownership of Medicaid or government healthcare claims and/or encounter systems 

• Deep understanding of: 

• Claims adjudication workflows 

• Managed care encounter reporting 

• CMS Medicaid reporting requirements 

• CPT/HCPCS/ICD coding structures 

• Substantial experience with healthcare data standards, including: 

• USCDI 

• HL7 / FHIR APIs 

• Standard code sets and validation frameworks 

• Experience translating regulatory and reporting requirements into system functionality 

• Experience operating within California state reporting environments strongly preferred 

• Experience modernizing or consolidating fragmented claims or encounter systems 

• Experience building submission engines, validation services, or transaction gateways 

• Familiarity with MITA and Medicaid Enterprise modernization 

• Experience enabling user-facing operational tools that improve data quality and compliance 

• Experience working in complex public-sector or managed care environments 

• Submitting entities have clear visibility into claims and encounter status and data quality 

• Validation and reconciliation workflows are transparent and standardized 

• Data quality improves at the point of submission rather than through downstream correction 

• Claims and encounter capabilities integrate cleanly with other DHCS operational systems 

• Operational accountability across delivery systems measurably increases