Healthcare today is complicated and confusing. Coupe Health changes that. Coupe delivers a different healthcare experience – one that is streamlined and simplified, saving our members time and money. At Coupe, we are passionate about transforming healthcare. Come join our team.
The Impact You Will Have
Coupe Health is hiring a Product Manager that will lead the team managing the intellectual property and logic that differentiate Coupe from traditional and alternative health plans. The team oversees rules, algorithms, and configurations for claims adjudication, episodic bundling, provider tiering, accumulators, and actuarial value—systems designed to simplify healthcare transactions and deliver employer savings. This role demands technical expertise in health benefits, strong leadership, and vision to keep our platform competitive. Decisions in this role shape claim outcomes, employer value, and Coupe's growth potential.
Your 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
Required Skills and Experience
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.
Preferred Skills and Experience
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
Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.
Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
Medical, dental, and vision insurance
Life insurance
401k
Paid Time Off (PTO)
Volunteer Paid Time Off (VPTO)
And more
To discover more about what we have to offer, please review our benefits page.
At Coupe Health, we are committed to paving the way for everyone to achieve their healthiest life. Coupe Health is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.
Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: Talent.Aqcuisition@coupehealth.com.
Coupe Health recruiters may contact you from emails ending with @bluecrossmn.com and @coupehealth.com.