Principal Product Manager, Claims and Encounters

Speridian Technologies•Sacramento, CA

1d•Remote

About The Position

California’s behavioral health system is undergoing one of the most significant transformations in its history. Driven by new legislation—including the Behavioral Health Services Act and related reforms—DHCS is working to modernize how behavioral health services are delivered, tracked, and improved across the state. The BHT initiative is a multi-year effort to re-architect the way DHCS partners with counties and providers to deliver care, measure outcomes, and produce transparency, and accountability. This work requires a new generation of digital tools, data infrastructure, and service delivery models. At its core, BHT is about making real changes in the lives of Californians—ensuring every dollar spent can be tied to improved access, quality, and health outcomes. We are seeking a strong, multidisciplinary, Principal Product Manager to drive the modernization of our claims and encounter capabilities supporting Behavioral Health Transformation (BHT). While DHCS receives claims and encounter submissions today, the systems are fragmented and lack transparency for counties, providers, and managed care plans. We are building user-facing operational software that enables submitting entities to directly manage submission quality, reconciliation status, and reporting accuracy — and to be accountable for the integrity of their data. This role requires deep, hands-on experience owning Medicaid claims and encounter systems. The ideal candidate understands adjudication workflows, CMS reporting requirements, healthcare interoperability standards, and how operational systems drive accountability. This is a senior individual contributor role operating and owning outcomes at the intersection of policy, operations, data standards, compliance, and engineering.

Requirements

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

Nice To Haves

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

Responsibilities

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

Stand Out From the Crowd

Upload your resume and get instant feedback on how well it matches this job.

Upload and Match Resume