Director of Product - Network

Accountabilities

• Define and scope network solutions for new markets, partnering with network, sales, and go-to-market teams to assess provider coverage, TPA capabilities, integrations, and operational feasibility before commitments are made.
• Develop detailed requirements for partner and TPA data exchanges, covering claims, pricing outputs, remittance, eligibility, file cadence, service levels, reconciliation, and other critical integration requirements.
• Own the network pricing lifecycle from signed rate sheets through ingestion, normalization, versioning, effective dating, validation, testing, auditability, and production release.
• Establish standards for network configuration, pricing accuracy, testing, and release management, ensuring changes that affect reimbursement are thoroughly validated before deployment.
• Own provider data structures and hierarchies, including sponsors, tax IDs, billing NPIs, and service locations, while creating measurable processes for network adequacy and directory accuracy.
• Evaluate new customer segments and group types, determining whether they align with the platform's capabilities and confidently communicating recommendations to commercial stakeholders.
• Identify downstream payment implications of network and pricing changes and coordinate proactively with financial services and payments teams to prevent operational issues.
• Translate complex healthcare and reimbursement requirements into clear product specifications that engineering and partner teams can implement successfully.
• Work independently to identify priorities, solve operational and product challenges, and continuously improve systems through automation and technology.

Requirements

• Extensive experience in healthcare reimbursement, including practical knowledge of billed, allowed, and paid amounts and methodologies such as fee schedules, percent-of-Medicare, per diem, case rates, DRG, and percent-of-charge.
• Professional experience within a health plan, TPA, repricing or payment-integrity organization, reference-based-pricing administrator, provider revenue-cycle organization, or network contracting environment.
• Hands-on familiarity with healthcare data exchange standards, including 837 claims, 835 remittance files, and eligibility files.
• Demonstrated ability to write precise integration and technical requirements that engineering or external technology teams can successfully build from.
• Strong commercial and client-facing skills, with the confidence to represent complex network and reimbursement solutions to brokers, TPA executives, health systems, and other senior stakeholders.
• A highly self-directed approach, with the ability to define priorities, make sound decisions, and operate effectively without a pre-defined roadmap.
• Sufficient technical fluency to interpret data models, write SQL queries, understand system relationships, and provide engineers with actionable technical direction without needing to be a production developer.
• Exceptional written communication skills, particularly for requirements documents, specifications, process definitions, and cross-functional documentation.
• Preferred experience with self-funded employer healthcare, including TPA administration, direct contracting, reference-based pricing, or captive arrangements.
• Experience leading or supporting platform migrations or claims-system implementations, including managing reporting and operational challenges following migration.
• Experience as a founder, early-stage operator, or product leader who has used automation and AI to replace manual operational processes is a plus.

Benefits

• Opportunity to shape healthcare network infrastructure with direct impact on pricing, claims, provider access, and payment operations.
• Senior-level ownership and autonomy in a mission-driven, fast-moving environment.
• Cross-functional exposure spanning product, network operations, sales, go-to-market, engineering, payments, and external healthcare partners.
• Opportunity to work on complex healthcare technology challenges affecting employers, providers, payers, TPAs, and millions of people.
• Collaborative environment that encourages challenging established practices and developing better ways of working.
• Exposure to emerging automation and AI approaches for improving healthcare operations.
• Remote work environment.
• Opportunity to contribute to a growing organization focused on reducing inefficiency and improving transparency across the healthcare system.