IQVIA

Product Manager, Capitation Adjudication

IQVIA$88K — $220K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree in Healthcare Administration, Information Systems, Business Administration, or related field or equivalent experience.
  • 7+ years of experience in healthcare payer or managed care operations.
  • 5+ years of hands-on experience with Capitation Adjudication systems like EZ-CAP.
  • Strong understanding of healthcare claims processing and capitation administration.
  • Experience in Agile software development environments.

Responsibilities

  • Manage and prioritize product enhancements for the Capitation Adjudication platform.
  • Gather and document business requirements and operational use cases.
  • Develop user stories and functional requirements with acceptance criteria.
  • Collaborate with engineering and QA teams throughout development.
  • Participate in Agile planning and backlog refinement sessions.
  • Evaluate product enhancements based on payer operations and client needs.
  • Support implementation and post-release activities to ensure product success.

Benefits

  • Flexible remote working arrangement within the United States.
  • Opportunity to shape product evolution in managed care.
  • Gain exposure to Agile project management and software development.
  • Collaborate with cross-functional teams including engineering and client services.
Full Job Description

Position Summary

Cedar Gate Technologies, an IQVIA business, is seeking a Product Manager to support the continued enhancement and delivery of our Capitation Adjudication platform. This role is ideal for someone who has worked directly within a health plan or managed care organization and understands the operational realities of payer administration, claims processing, and capitation management.

The successful candidate will leverage real-world payer experience to help guide product enhancements, define requirements, support delivery activities, and collaborate with cross-functional teams to ensure our platform continues to meet client and business needs. This position works closely with Product, Engineering, Quality Assurance, Operations, Client Services, and Implementation teams to drive successful product outcomes and support a growing client base.

If you have deep experience supporting Capitation Adjudication in a payer environment and are interested in helping shape the future of the platform, we encourage you to apply.

Roles & Responsibilities

  • Manage and prioritize product enhancements and backlog items for the Capitation Adjudication platform.
  • Gather, analyze, and document business requirements and operational use cases.
  • Develop user stories, functional requirements, and acceptance criteria.
  • Collaborate with engineering and quality assurance teams throughout the software development lifecycle.
  • Participate in Agile planning activities, backlog refinement sessions, sprint reviews, and release preparation.
  • Help evaluate product enhancements through the lens of real-world payer operations and client needs.
  • Support implementation, testing, release readiness, and post-release activities.
  • Partner with internal stakeholders to identify opportunities for product improvements and operational efficiencies.
  • Assist with product demonstrations, client discussions, and subject matter expertise related to Capitation Adjudication functionality.
  • Contribute to product roadmap planning through feedback from clients, operational teams, and market requirements.

Job Location

United States 6 Remote

Work Arrangement

U.S. residents only; work must be performed within the United States.

Experience / Qualifications

  • Bachelor9;s degree in Healthcare Administration, Information Systems, Business Administration, or a related field, or equivalent experience.
  • Seven or more years of experience in healthcare payer, managed care, or health plan operations.
  • Five or more years of hands-on experience working with Capitation Adjudication (like EZ-CAP) in a production environment.
  • Experience supporting payer operations after go-live, including ongoing production support, issue resolution, process improvements, or system enhancements.
  • Experience gathering business requirements and translating them into functional solutions.
  • Strong understanding of healthcare claims processing, capitation administration, provider reimbursement, or managed care operations.
  • Excellent communication, organizational, and stakeholder management skills.
  • Experience working in Agile or Scrum-based software development environments.
  • Experience supporting multiple functional areas within Capitation Adjudication, such as claims, authorizations, capitation, benefits, provider administration, or EDI is preferred.
  • Experience working with value-based care, risk-based payment models, or capitated products is highly preferred.
  • Previous experience supporting Cedar Gate Technologies9 Capitation Adjudication platform, EZ-Cap, from the client side, would be the ideal preferred candidate.
  • Experience participating in implementation projects, upgrades, conversions, or major system enhancements would be nice.
  • Some familiarity with JIRA, Confluence, SQL, reporting tools, or healthcare operational reporting.
  • Certified Scrum Product Owner (CSPO), Agile certification, or similar professional certifications are preferred.
  • To be eligible for this position, you must reside in the same country where the job is located.

The potential base pay range for this role, when annualized, is $88,100.00 - $220,200.00. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.

About IQVIA

Innovex offers superior and creative advice to corporations. In addition, they raised venture capital for our own affiliate companies, in addition to having assisted clients in fund-raising efforts, new venture outreaches, and financing. Their engineers and technical staff offer varied backgrounds in manufacturing, high tech, product design, quality control, safety, biomechanics, and robotics.

IQVIA Careers

Join the vibrant team at IQVIA, a leading global provider of advanced analytics, technology solutions, and clinical research services to the healthcare industry. IQVIA is recognized for its commitment to innovation, leadership in healthcare, and a culture that celebrates diversity and inclusion.

Work You’ll Do

At IQVIA, we offer job opportunities that empower you to leverage your skills and drive healthcare forward. Become part of a team that thrives on innovation and the pursuit of operational excellence, helping to improve patient outcomes across the globe.

Transform Your Career

IQVIA is the place where you can transform the world of healthcare while advancing your career. With a variety of positions available, from research and development to business analytics, IQVIA is at the forefront of the industry. Our leadership is committed to fostering a culture of growth and professional development, making IQVIA a prime environment for both seasoned professionals and those seeking an internship to kickstart their career.

Innovative Work Environment

Join over 50,000 dedicated professionals in a dynamic environment where technology meets healthcare. At IQVIA, innovation isn’t just a buzzword; it's the backbone of how we solve complex challenges. With cutting-edge resources and a collaborative global team, your work at IQVIA directly contributes to advancements in life sciences.

Career Development and Benefits

IQVIA believes in nurturing its team members not just as employees but as individuals seeking to grow their careers. We support this with unmatched benefits, diversity training, and opportunities for leadership development. Our commitment to your career growth is matched by our dedication to providing a supportive and inclusive workplace.

Explore Job Opportunities

Whether you’re looking for a full-time position, part-time work, or a graduate internship, IQVIA offers a range of employment options to match your career ambitions. Our hiring process is designed to be transparent and engaging, helping you to understand where your skills can best be utilized within the company.

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At IQVIA, networking and professional development are part of our DNA. Engage with industry leaders, participate in global conferences, and take advantage of our in-house training programs designed to enhance your skills and advance your career.

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Learn more about IQVIA
Size
82,000 employees
Market Cap
$37.5 billion
Industry
Net Income
$279 million
Founded
2016
5 Year Trend
+15.3%
Revenue
$11.3 billion
NASDAQ

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