Description

You will own the product strategy and delivery for Payment Integrity products.

Responsibilities

• Define and own the end-to-end product vision and multi-year roadmap for Payment Integrity products (pre-payment, post-payment, claims analytics, audit workflows, rules engines, etc.).
• Lead cross-functional teams (engineering, data science, claims operations, finance) to deliver scalable Payment Integrity solutions.
• Translate business needs into actionable product requirements, user stories, and acceptance criteria.
• Partner with finance and operations to track product performance against KPIs like overpayment recovery rate and detection yield.
• Ensure solutions meet regulatory and audit requirements by collaborating with Compliance, Legal, and Provider Management.

Required Skills

• 6+ years of product management experience, preferably in healthcare, insurance, payment integrity, claims processing, or fintech risk & controls.
• Strong understanding of claims lifecycle, reimbursement methodologies, pre-payment edits, post-payment audits, and fraud/waste/abuse detection.
• Experience working directly with engineering, analytics, and data science teams.
• Proficiency in data analysis, KPI development, and financial impact modeling.
• Exceptional communication, stakeholder management, and leadership skills.
• Ability to prioritize effectively in a demanding environment with competing demands.

Preferred Skills

• Experience with payment integrity platforms, claims adjudication systems, workflow tools, or rules engines.
• Background in healthcare regulations (CMS, Medicare/Medicaid guidelines, ICD/CPT coding).
• Certifications such as CSPo, Pragmatic PM, or AIPMM.

Key Skills

Education

Not specified