Product Manager

Primary Skills

CSPO

Specialization

Product Management: Senior Software Development Lead

Key Responsibilities

Product Strategy & Vision

· 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.).

· Identify market, regulatory, and industry trends to shape strategic product decisions.

· Develop business cases, cost–benefit analyses, and value propositions for new capabilities.

Execution & Delivery

· 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.

· Prioritize the product backlog using a data driven approach while balancing long term strategy and short term wins.

· Drive iteration planning, sprint reviews, and release cycles with engineering.

Operational & Financial Impact

· Ensure solutions reduce payment leakage, improve claims accuracy, and support audit effectiveness.

· Partner with finance and operations to track product performance through KPIs such as overpayment recovery rate, detection yield, cost avoidance, and operational efficiency.

· Continuously optimize rules engines, fraud/waste/abuse detection algorithms, and workflow systems.

Stakeholder Management

· Work closely with internal teams (Compliance, Legal, Provider Management, Medical Policy) to ensure solutions meet regulatory and audit requirements.

· Partner with external vendors, payment integrity service providers, and technology partners.

· Communicate product vision, updates, and performance metrics to senior leadership.

User Experience & Product Quality

· Advocate for intuitive user experiences for auditors, analysts, clinicians, and claims processors.

· Ensure robust product documentation, training materials, and operational readiness.

· Drive continuous improvement by collecting user feedback and monitoring adoption.

Required Qualifications

· 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 with engineering, analytics, and data science teams.

· Proficient with data analysis, KPI development, and financial impact modeling.

· Exceptional communication, stakeholder management, and leadership skills.

· Ability to prioritize in a fast paced environment with competing demands.

Preferred Qualifications

· Experience with payment integrity platforms, claims adjudication systems, workflow tools, or rules engines.

· Background in healthcare regulations (CMS, Medicare/Medicaid guidelines, ICD/CPT coding).

· Exposure to machine learning based anomaly detection or predictive models.

· Product certifications (CSPO, Pragmatic PM, AIPMM, etc.).

· MBA or equivalent experience in strategy-heavy roles.

Success Measures

· Reduction in payment leakage and increase in cost avoidance.

· Improved claims accuracy and audit efficiency.

· Delivery of high impact features aligned with roadmap timelines.

· Strong adoption