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