Lead Product Manager
About the role
We are seeking a strategic and execution-focused Lead Product Manager to drive innovative new initiatives within the Claims Administration and Payment Integrity (CAPI) organization in the Claims domain.
Responsibilities
This person will play a critical role in the cross-initiative (intra-ART) execution space but also includes product ownership with measurable outcomes for AI-driven solutions including Claims Control Tower, Provider fingerprinting, and integration of claims audit applications.
Develop and manage (with business and engineering partners) the vision, strategy, and roadmap for all AI-driven applications in the Payment Integrity space.
Ensure that findings from anomaly detection solutions are matched to existing findings to ensure that either 1) they are scrubbed out of findings presented to users, or 2) they are presented to users, with the outcomes from users fed into existing applications.
Manage the interconnectedness of CAPI solutions including vendor integration and backend support, aligned with organizational goals and regulatory requirements.
Translate business needs into clear product capabilities and deliverables, focused on how existing products (including internal and vendor-managed) work together.
Prioritize initiatives across claims prepay, postpay, and audit functions to maximize impact on cost avoidance, recovery, and operational efficiency.
Ensure that anomalies are tracked from identification to de-duplication to research to resolution and back to the LLM to enable reporting and business value articulation.
Work with architects and engineering to determine the “how.”
Represent the CPI ART in the broader CAPI intake process. Identify and assess impacts to the CPI ART teams and bring those to impacted Product Managers.
Understand and educate users on impacts to business workflows supporting claims audit operations, including anomaly detection, prepay edits, postpay reviews, and recovery processes.
Gather and synthesize feedback from end users to continuously improve anomaly detection and product connectivity.
Partner with IT and engineering teams to design, build, implement, and support technology products and platforms.
Create and manage detailed product requirements, user stories, and acceptance criteria.
Participate in agile ceremonies, ensuring alignment between business priorities and technical execution.
Oversee product releases, enhancements, and lifecycle management for your CAPI responsibilities.
Drive innovation in claims auditing capabilities, including rule engines, analytics, and automation tools.
Support development of new prepay and postpay strategies to identify fraud, waste, and abuse (FWA).
Ensure solutions are scalable and adaptable to evolving regulatory and reimbursement environments.
Define and track key performance indicators (KPIs) to measure product success (e.g., savings, accuracy, audit yield, turnaround time).
Partner with analytics teams to develop reporting and dashboards that demonstrate business value and ROI.
Communicate outcomes and value realization to senior leadership and stakeholders.
Lead cross-functional communication to ensure alignment on priorities, timelines, and outcomes.
Support change management efforts, including training, documentation, and adoption strategies.
Act as an advocate for both business and technology stakeholders.
Qualifications
Strong SME (subject matter expert) knowledge and experience in payment integrity operations, business processes, and technology products including key vendors, or strong product management expertise and a product mindset for delivery.
5+ years of Product Management experience, specifically leading design and development of software, data, or analytics products including roadmap development and management, results tracking, stakeholder and user relationship management and communication, investment cost justification, etc.
3+ years of Agile experience, specifically leading development and delivery of solutions that enable business value including use of tools like Jira, Jira Align, ADO (Azure Dev Ops), etc. and involvement in Agile ceremonies.
Experience working with cross-functional teams, including business operations and IT/engineering.
Proven ability to translate complex business needs into scalable technology solutions.
Strong analytical and problem-solving skills with a data-driven mindset.
Bonus
The role is eligible for a bonus incentive plan based upon company and/or individual performance.