Remote Claims Processing Jobs in Spring, TX (NOW HIRING)

About Cedar Gate Technologies

Cedar Gate Technologies, an IQVIA business, enables payers, providers, employers, and service administrators to excel at value-based care with a unified technology and services platform delivering analytics, care, and payment technology on a single data management foundation. At Cedar Gate, you'll be part of a collaborative, innovative environment where great ideas thrive. We invest deeply in our people through ongoing training, comprehensive benefits, and a strong culture of teamwork, offering the chance to grow your skills while contributing to high impact initiatives for some of the world's most dynamic companies.

Position Summary

Cedar Gate Technologies, an IQVIA business, is seeking a Product Manager to support the continued enhancement and delivery of our Capitation Adjudication platform. This role is ideal for someone who has worked directly within a health plan or managed care organization and understands the operational realities of payer administration, claims processing, and capitation management.

The successful candidate will leverage real-world payer experience to help guide product enhancements, define requirements, support delivery activities, and collaborate with cross-functional teams to ensure our platform continues to meet client and business needs. This position works closely with Product, Engineering, Quality Assurance, Operations, Client Services, and Implementation teams to drive successful product outcomes and support a growing client base.

If you have deep experience supporting Capitation Adjudication in a payer environment and are interested in helping shape the future of the platform, we encourage you to apply.

Roles & Responsibilities

• Manage and prioritize product enhancements and backlog items for the Capitation Adjudication platform.
• Gather, analyze, and document business requirements and operational use cases.
• Develop user stories, functional requirements, and acceptance criteria.
• Collaborate with engineering and quality assurance teams throughout the software development lifecycle.
• Participate in Agile planning activities, backlog refinement sessions, sprint reviews, and release preparation.
• Help evaluate product enhancements through the lens of real-world payer operations and client needs.
• Support implementation, testing, release readiness, and post-release activities.
• Partner with internal stakeholders to identify opportunities for product improvements and operational efficiencies.
• Assist with product demonstrations, client discussions, and subject matter expertise related to Capitation Adjudication functionality.
• Contribute to product roadmap planning through feedback from clients, operational teams, and market requirements.

Job Location

United States - Remote

Work Arrangement

U.S. residents only; work must be performed within the United States.

Experience / Qualifications

• Bachelor's degree in Healthcare Administration, Information Systems, Business Administration, or a related field, or equivalent experience.
• Seven or more years of experience in healthcare payer, managed care, or health plan operations.
• Five or more years of hands-on experience working with Capitation Adjudication (like EZ-CAP) in a production environment.
• Experience supporting payer operations after go-live, including ongoing production support, issue resolution, process improvements, or system enhancements.
• Experience gathering business requirements and translating them into functional solutions.
• Strong understanding of healthcare claims processing, capitation administration, provider reimbursement, or managed care operations.
• Excellent communication, organizational, and stakeholder management skills.
• Experience working in Agile or Scrum-based software development environments.
• Experience supporting multiple functional areas within Capitation Adjudication, such as claims, authorizations, capitation, benefits, provider administration, or EDI is preferred.
• Experience working with value-based care, risk-based payment models, or capitated products is highly preferred.
• Previous experience supporting Cedar Gate Technologies' Capitation Adjudication platform, EZ-Cap, from the client side, would be the ideal preferred candidate.
• Experience participating in implementation projects, upgrades, conversions, or major system enhancements would be nice.
• Some familiarity with JIRA, Confluence, SQL, reporting tools, or healthcare operational reporting.
• Certified Scrum Product Owner (CSPO), Agile certification, or similar professional certifications are preferred.
• To be eligible for this position, you must reside in the same country where the job is located.

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more athttps://jobs.iqvia.com

IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. https://jobs.iqvia.com/eoe

IQVIA is committed to integrity in our hiring process and maintains a zero tolerance policy for candidate fraud. All information and credentials submitted in your application must be truthful and complete. Any false statements, misrepresentations, or material omissions during the recruitment process will result in immediate disqualification of your application, or termination of employment if discovered later, in accordance with applicable law. We appreciate your honesty and professionalism.