Product Management Senior Advisor (Medicaid Encounter Operations)

Location: Hybrid in Bloomington, Minnesota, United States. Occasional or permanent work from home requires cable broadband or fiber internet with at least 10 Mbps download and 5 Mbps upload speeds.

Annual salary: $113,200–$188,600, depending on experience and geographic location. Eligible for an annual bonus plan.

Company

hirify.global's Evernorth Health Services division develops pharmacy, care, and benefit solutions designed to improve health outcomes and access to treatment.

What you will do

• Monitor Medicaid encounter submission processes and ensure accurate, compliant file delivery to states and clients.
• Analyze operational data, performance metrics, and trends to identify risks and recommend improvements.
• Investigate encounter rejections, conduct root cause analysis, and lead remediation in line with state guidance and regulatory requirements.
• Translate data and findings into recommendations that support leadership decisions and business priorities.
• Partner with cross-functional teams to improve processes, operational efficiency, and strategic initiatives.
• Provide subject-matter expertise, documentation, status updates, and issue resolution for internal stakeholders, account teams, states, and clients.

Requirements

• At least 5 years of experience in business analysis, healthcare operations, compliance, product management support, or a related field.
• Strong analytical skills, including interpreting large datasets, identifying trends, uncovering root causes, and developing recommendations.
• Advanced proficiency in Microsoft Excel and other Microsoft Office applications.
• Experience gathering, analyzing, and validating data from multiple systems and sources.
• Ability to collaborate across functions, influence outcomes, present information, and communicate effectively with diverse audiences.
• Customer-focused approach with the ability to balance detailed execution and broader strategic objectives.

Nice to have

• Experience in pharmacy benefit management, healthcare, managed care, or health services.
• Experience with Medicaid programs, encounter operations, claims processing, or healthcare compliance.
• Knowledge of state and federal healthcare regulations.
• Experience with clients, account teams, Tableau, SQL, reporting, or data visualization tools.
• Bachelor's degree or equivalent practical experience, plus experience leading process improvement initiatives.

Culture & Benefits

• Medical, vision, dental, well-being, and behavioral health benefits available from the first day of employment.
• 401(k), company-paid life insurance, tuition reimbursement, paid holidays, and leaves of absence.
• At least 18 days of paid time off per year.
• Work environment focused on collaboration, continuous improvement, learning, and operational excellence.