Director of Product - Network

4 weeks, 1 day ago
Full-time
Executive
Product Management
Nomi Health

Nomi Health

Nomi Health is a healthcare services provider that supports medical testing & self insured healthcare plan administration. Become a part of the direct healthcare revolution and join our growing network of providers. You can also tap into our technology...

Insurance
251-1K
Founded 2019
$110M raised

Description

  • Define market solutions with network, go-to-market, and sales teams, including provider coverage, TPA capabilities, and integration sequencing.
  • Write detailed data-exchange requirements covering claims, pricing outputs, remittance, eligibility, file cadence, SLAs, and reconciliation.
  • Own network pricing configuration from rate-sheet ingestion through normalization, versioning, validation, effective dating, testing, release, and audit.
  • Manage provider data models and hierarchies while measuring network adequacy and directory accuracy.
  • Evaluate new group types and market segments and recommend whether they fit Nomi’s capabilities.
  • Identify payment implications of network changes and coordinate with financial services and payments teams.
  • Represent Nomi with brokers, TPA executives, and health systems while making commercially viable commitments.

Requirements

  • Hands-on understanding of billed, allowed, and paid amounts and reimbursement methodologies including fee schedules, percent of Medicare, per diem, case rate, DRG, and percent of charge.
  • Professional background in a health plan, TPA, repricing or payment-integrity vendor, reference-based-pricing administrator, provider revenue-cycle organization, or network contracting organization.
  • Experience with 837, 835, and eligibility file exchanges.
  • Ability to write integration and product requirements that engineering teams can implement successfully.
  • Experience representing solutions to brokers, TPA executives, or health systems.
  • Self-directed ability to set priorities without a predefined roadmap.
  • Technical fluency sufficient to read data models, write SQL, and provide clear engineering direction; production coding is not required.
  • Strong written communication and requirements documentation skills.
  • Preferred experience in self-funded employer healthcare, including TPA administration, direct contracting, reference-based pricing, or captives.
  • Preferred experience leading platform migrations or vendor claims-system implementations, or using automation and AI to replace manual operational work.

Interested in this position?

Apply directly on the company website

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