About Coupe Health

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