Product Manager, Audit and Complaints

Job Ref: TE0053

Category: Professional

Department: MHP PRODUCT

Location: 50 Water Street, 7th Floor,
New York,
NY 10004

Job Type: Regular

Employment Type: Full-Time

Work Arrangement: Hybrid

Salary Range: $125,000.00 - $135,000.00

Position Overview

Reporting to the Director of Product Enrollment, the Product Manager, Audit and Complaints, ensures operational excellence and regulatory compliance in working with cross departmental teams to ensure Regulatory and Compliance Audits and Complaints are researched and responded to timely.

Scope of Role & Responsibilities

• Lead the intake, investigation, tracking, and resolution of regulatory complaints.
• Ensure timely and accurate responses to state and federal agencies, including DOI, CMS, and state Medicaid agencies.
• Oversee the intake, triage, investigation, and resolution of member and provider complaints related to product design, benefits, and operational processes.
• Identify trends, root causes, and systemic issues, partnering with cross-functional teams to implement steps for correction.
• Facilitate corrective action planning approach, remediation strategy, and progress tracking through closure.
• Establish governance, mechanisms, and controls to monitor risk, complaint patterns, and audit outcomes to provide actionable insights to leadership.
• Drive continuous improvement initiatives by translating findings into scalable product enhancements and operational solutions.
• Coordinate audit preparation, document collection, SME engagement, and response development with Compliance Department.
• Review product materials, benefit designs, member communications, and operational processes for regulatory alignment.
• Prepare reports and presentations for senior leadership, governance committees, and regulatory bodies

Required Education, Training & Professional Experience:

• Bachelor's degree from an accredited college or university in an appropriate discipline required.
• Master's degree in business, healthcare or public administration preferred.
• Minimum 7-10 years experience at a Health Plan in a product management or compliance role.
• Knowledge of Medicaid and Medicare products and regulatory environment in NYS
• Experience managing regulatory complaints and/or audits in a health plan environment
• Demonstrated ability to identify opportunities for improvement & implement solutions.

Professional Competencies:

• Ability to work cross-functionally and influence without direct authority
• Process improvement and Business Acumen
• Data-driven decision-making
• Excellent written & verbal communication skills
• Ability to work effectively in a fast-paced & constantly evolving environment
• Highly collaborative and demonstrating good judgment in seeking consensus & input from multiple stakeholders to drive decision-making
• Demonstrate understanding & acceptance of the MetroPlus Mission, Vision, & Values

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