Lead Product Manager

Become a part of our caring community   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. This role is responsible for developing and managing the long-term deployment of new AI-driven solutions – in partnership with business and engineering partners – to help fast-track identification of claims payment anomalies. This person will also ensure coordination between new and existing tools as well as the connections and collaboration across Claims Payment Integrity (CPI) tools and applications. They will be involved in the development, implementation, and continuous improvement of prepay and postpay claim audit processes, enabling operational efficiency, and delivering measurable business value through our products. In addition, this role will represent the CPI ART (Agile Release Train) at CAPI intake meetings, ensuring that impacts to CPI teams are identified and assessed as part of the intake process. The ideal candidate is a strong cross-functional leader who partners closely with business stakeholders, operations teams, and IT to deliver scalable, high-impact solutions that improve claims accuracy, reduce waste, and optimize compliance. The role is expected to bring structure and influence to help organize and advance the maturity of the CPI ART. Key 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. Product Connectedness & Enablement 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. Ensure that all results are fed back to the large language models (LLM) to ensure continuous learning and advancement of the AI. 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. Business Partnership & Enablement Ensure that anomalies are tracking 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.” Ensure that the user interface for anomaly detection tools is designed, implemented, and continuously improved. Work with architects and engineering to determine where the UI should sit. 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. Serve as the primary liaison between business stakeholders (claims operations, audit teams, SIU, compliance) and technology teams for your products. 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. Technology Delivery & IT Collaboration 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. Payment Integrity Optimization 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. Data & Value Realization 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. Stakeholder Communication & Change Management 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. Use your skills to make an impact   Required Qualifications Candidate should bring either a) strong SME (subject matter expert) knowledge and experience in payment integrity operations, business processes, and technology products including key vendors, or b) strong product management expertise and a product mindset for delivery. Must also have experience applying an Agile framework to deliver large scale products in a healthcare environment. Bachelor’s degree in Business, Healthcare Administration, Information Systems, or related field is desired. 5+ years of Product Management experience, specifically leading design and development of software, data, or analytics products