Product Manager

Coupe Health is transforming healthcare to create a streamlined and simplified experience for its members. They are seeking a Product Manager to lead a team focused on managing the intellectual property and logic that differentiates Coupe from traditional health plans, overseeing claims adjudication and ensuring competitive platform growth.

Responsibilities:

• Lead and mentor an established team of benefits analysts, configuration specialists, and savings modelers
• Set team priorities and manage capacity across ongoing operations, new implementations, and strategic initiatives
• Establish processes and standards that enable the team to scale with Coupe's growth
• Partner with Technology and Operations leadership to ensure alignment on roadmap and resource planning
• Own the end-to-end product definition for Coupe's claims adjudication rules engine, including benefit application, member cost-share calculations, and payment orchestration
• Define adjudication logic including service classification, place-of-service rules, modifier handling, and benefit mapping
• Own the logic that groups related services into coherent care episodes with transparent, predictable pricing
• Establish bundling methodologies for high-value episode types including surgical procedures, maternity, imaging, and chronic condition management
• Own the provider tiering methodology that classifies providers into performance tiers based on cost, quality, and efficiency signals
• Lead the team's efforts to model projected claims savings for prospective employer customers
• Oversee the development and refinement of savings calculators and modeling tools that quantify expected value from Tier 1 steerage, site-of-care optimization, and episode-based pricing
• Partner with actuarial and finance teams to define plan configurations that achieve target actuarial values while maintaining benefit simplicity
• Lead the initiative to productize core capabilities into distinct, reusable services available through a modern service architecture
• Define configuration schemas and parameters that enable rapid deployment of new plan designs without custom development
• Establish clear boundaries between core platform capabilities and partner-specific customizations
• Ensure all benefit logic complies with federal and state regulatory requirements across all active markets

Requirements:

• 7+ years of experience in health plan operations, benefits administration, or healthcare product management. All relevant experience including work, education, transferable skills, and military experience will be considered
• Proven leadership experience managing teams of analysts, configuration specialists, or benefits operations professionals
• Expert-level knowledge of claims adjudication mechanics including benefit mapping, COB, service classification, and payment calculation
• Strong understanding of episodic or bundled payment methodologies including episode construction, triggering logic, and pricing approaches
• Experience designing or implementing provider tiering programs with measurable steerage outcomes
• Demonstrated ability to model claims savings, build repricing analyses, and develop defensible assumptions for prospective employer engagements
• Demonstrated understanding of actuarial concepts including actuarial value, plan richness, benefit relativities, and cost-share modeling
• Experience translating complex benefit requirements into technical specifications for development teams
• Strong analytical skills with the ability to work directly with claims data to validate logic, identify anomalies, and quantify impacts
• Familiarity with healthcare data standards including EDI 837/835 transactions, CPT/HCPCS coding, and ICD classification
• High school diploma (or equivalency) and legal authorization to work in the U.S
• Bachelor's degree in a relevant field; advanced degree, actuarial credentials, or clinical background
• Direct experience building or operating alternative health plan models, value-based benefit designs, or reference-based pricing programs
• Deep expertise in specific bundling methodologies (Prometheus, ETGs, MEGs, or proprietary approaches)
• Experience with provider performance measurement including cost efficiency scoring, quality metrics integration, and network optimization
• Track record of developing savings models or repricing tools used in sales cycles to win new business
• Knowledge of pharmacy benefit structures including PBM integration, formulary tiering, specialty drug management, and Rx cost-share mechanics
• Understanding of healthcare financing products including HSAs, HRAs, and point-of-sale financing solutions
• Experience productizing complex operational capabilities into configurable, API-driven platform services
• Background in healthcare regulatory compliance including ACA, ERISA, mental health parity, and state insurance requirements
• SQL proficiency and experience with claims data warehouses for analysis, validation, and impact modeling
• Familiarity with healthcare interoperability standards including FHIR and price transparency requirements