ACA Enrollment & Membership Solutions Product consultant

Required Experience

• 10–15+ years of experience in ACA healthcare software product development.
• 8+ years in Product Management, Senior Business Analysis, Product Ownership, or Solution Architecture.
• Proven experience building or enhancing commercial healthcare software products (not implementation-only experience).
• Strong understanding of end-to-end ACA eligibility, enrollment, and membership administration processes.

Functional Expertise

Candidates should demonstrate expertise in:

• ACA Eligibility & Enrollment
• Individual & Family Marketplace Products
• Small Group Enrollment
• Federal Marketplace
• State-Based Marketplaces
• Enhanced Direct Enrollment
• Open Enrollment & Special Enrollment Periods
• Qualified Health Plans
• APTC & Cost Sharing Reduction
• Membership Lifecycle Management
• Plan Administration
• Broker & Agency Enrollment
• Premium Billing Integration
• Member Services

Integration & EDI Knowledge

Strong understanding of healthcare integrations including:

• 834 Enrollment
• 820 Premium Payment
• 270/271 Eligibility Verification
• 999/277 Acknowledgements
• REST APIs and modern integration patterns

Preferred Qualifications:

• Bachelor's degree in Computer Science, Information Systems, Healthcare Administration, Business, or a related field.
• Experience working with ACA health plans, regional Blues, Medicaid Managed Care Organizations, or national payers.
• Familiarity with cloud-native, API-first product architectures and AI-driven healthcare solutions.