About this opportunity
AIToolboard lists this Senior Product Manager - Health Plan Data & AI Products opportunity in columbia, South Carolina. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Jobs / Senior Product Manager - Health Plan Data & AI Products
Senior Product Manager - Health Plan Data & AI Products
Full-time
About the Role
About the positionMedisolv partners with hospitals, health systems, ACOs, and payers to bring clarity to quality data, connecting clinical and claims information into a single, reliable view. Over 1,800 organizations and 130M+ patient records rely on Medisolv to measure, report, and improve performance across 500+ measures tied to CMS, The Joint Commission, and other programs. With support from Bessemer Venture Partners Forge, Medisolv is continuing to grow its platform and expand its impact by investing in advanced analytics, AI, and new capabilities that help healthcare organizations stay ahead of change and improve outcomes with confidence. This role is for someone who knows the health insurance and VBC worlds inside out, understands the math behind CMS quality calculations, and is excited about putting autonomous AI agents to work on healthcare data.
Responsibilities
Build a deep understanding of Medisolv’s data ecosystem and CMS measure logic (HEDIS, Pharmacy, CAHPS/HOS).
Align with engineering, AI, and clinical stakeholders on priorities and high-impact use cases.
Define initial AI agent architecture and guiding principles for HITL safety and compliance.
Design and prototype AI agents to identify care gaps and predict Star Rating risks.
Stand up the foundation of the payer data core from fragmented datasets.
Develop initial CMS measure calculation engines and pilot action-oriented workflows.
Deploy production-ready AI agents that connect insights directly to gap-closing actions.
Expand and stabilize the payer data core and measurement automation.
Implement orchestrated workflows and mature HITL guardrails.
Optimize AI performance with feedback loops and expand to more advanced use cases.
Mature the data platform into a scalable, real-time decisioning engine.
Drive measurable improvements in Star Ratings and value-based care outcomes.
Requirements
5+ years of product management experience handling health plan data and VBC provider quality metrics.
Deep understanding of risk adjustment, utilization management, and how risk-bearing entities operate.
Expertise in how CMS calculates MA Star Ratings, including the math behind cut points and the impact of triple-weighted measures.
Ability to build data products that move the needle across various CMS measure domains.
Hands-on experience working with claims, eligibility, and enrollment datasets, and mapping them back to quality performance.
Experience building proactive software that thinks, adapts, and automates workflows, rather than just reporting on them.
Understanding of GenAI architectures, RAG, and agentic frameworks (like LangChain, AutoGen, or similar orchestration toolsets).
Comfortable talking to engineers about vector databases, APIs, and semantic data layers.
Understanding of HIPAA/HITRUST guidelines and how to build AI outputs that are accurate, unbiased, and explainable.
Takes initiative and enjoys driving tasks from inception to completion.
Demonstrates and influences cross-functional collaboration within the company.
Seeks out opportunities to build relationships with others even when difficult personalities or politics stood in the way.
Flexibility and adaptability to changing environments as a company grows and scales.
Intellectual curiosity and a love for figuring out how things work.
Resilience and optimism; embraces change.
Nice-to-haves
Experience with Bessemer Venture Partners Forge.
Experience with autonomous AI agents.
Benefits
Support from Bessemer Venture Partners Forge
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Worksite address
columbia, SC, 29228, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.