RemoteLeaf Logo
Log in Sign up

Complex Clinical Audit Business Solutions Lead

16 hours, 50 minutes ago
India, United States
Full-time
Lead
Product Manager
Product Management
Generative AI LLM NLP
Apply Now
Abacus Insights

Abacus Insights

Abacus Insights simplifies healthcare data with intelligent solutions, unlocking data value and empowering health plans, consumers, and providers.

Insurance
51-250
Founded 2017
$82M raised
View All Jobs 4

Description

  • Serve as the primary operational subject matter expert for payment integrity methodologies, audit programs, and product requirements.
  • Translate payer pain points, contract language, audit policy, and operational workflows into product capabilities.
  • Define audit concepts, savings opportunities, validation criteria, and defensibility standards across priority payment integrity domains.
  • Partner with engineering to define, develop, and build scalable, trustworthy, reliable, and accurate AI solutions.
  • Support roadmap prioritization, pilot launches, outcome reviews, product positioning, and customer expansion.
  • Collaborate with product, engineering, AI Engineering, clinical, operations, customer success, and payer stakeholders.
  • Use internal AI-enabled tools to create prototypes, visualize workflows, and showcase product functionality.
  • Champion internal AI tools to accelerate ideation, solution design, and product demonstrations.

Requirements

  • 5–10+ years of progressive experience in Payment Integrity, healthcare audit, clinical operations, or healthcare technology product management.
  • Deep knowledge of U.S. healthcare payer payment integrity programs, including pre-pay and post-pay audit strategies, vendor management, savings methodologies, recovery operations, and performance measurement.
  • Understanding of payer regulatory, compliance, and audit considerations that impact payment integrity program design and execution.
  • 3+ years in a PI-domain leadership role such as audit operations, PI program management, vendor product management, or payer PI strategy.
  • Strong working knowledge across multiple PI domains, including DRG audit, clinical validation, IBR, edit-based audits, observation, readmissions, COB, SIU, and UM adjacencies.
  • Experience translating audit operations, clinical content, and payer requirements into software workflows, analytics, or product requirements.
  • Strong analytical and communication skills, with comfort using hit-rate analysis, ROI modeling, outcome measurement, and executive-ready narratives.
  • Familiarity with claims processing, adjudication systems, provider billing, UB-04 data structures, and healthcare interoperability standards.
  • Experience partnering directly with Product Management, Engineering, Data Science, AI Engineering, or Clinical Informatics teams to build software solutions (preferred).
  • Familiarity with Generative AI, LLMs, NLP, prompt engineering, or healthcare AI applications (preferred).
  • Understanding of recovery workflows, eligibility verification, accident-related claims, third-party liability, workers’ compensation, and other payment responsibility determinations (preferred).
  • Familiarity with FWA investigation methods, claim anomaly detection, provider billing patterns, and healthcare fraud prevention programs (preferred).
  • Experience identifying opportunities to integrate COB, subrogation, FWA, and payment integrity data to improve savings identification and recovery outcomes (preferred).
  • Experience defining business requirements, user stories, acceptance criteria, and product specifications (preferred).

Benefits

  • Competitive leave and benefits.
  • Comprehensive health coverage.
  • Equity for every employee.
  • Growth-focused environment with support for employee development.
  • Remote role with US working hours (Eastern time zone).

Interested in this position?

Apply directly on the company website

Apply Now

Similar Roles

Coursera

Principal Product Manager, Mobile

Coursera 1K-5K Internet Software & Services

Coursera + Udemy is hiring a Principal Product Manager to define and lead the mobile strategy for a large-scale learning app used by millions of learners.

United States Full-time Lead Product Manager
$180k-$262k
Android iOS
16 hours, 35 minutes ago
roo.vet

Product Manager

roo.vet 11-50 Health Care Providers & Services

Roo is hiring a Product Manager to help drive its labor marketplace for veterinary professionals by turning ideas into shipped product and measurable business impact.

United States Full-time Junior Product Manager
$100k-$165k
Prototyping
16 hours, 35 minutes ago
Xebia

Senior Product Manager

Xebia 1K-5K Internet Software & Services

Xebia is hiring a Product Manager to lead ML-powered scoring capabilities for Sponsored Offers, shaping product strategy and delivery across data science, engineering, and business teams.

Poland Europe Senior Product Manager
AWS Azure Databricks GCP Generative AI Machine Learning Snowflake
16 hours, 35 minutes ago
Campminder

Senior Product Manager, AI Platform

Campminder 51-250 Internet Software & Services

Campminder is seeking a Senior Product Manager of AI Platform to build the shared AI foundation and drive adoption of AI capabilities across its camp software products.

United States Full-time Senior Product Manager
$180k-$220k
LLM Machine Learning MLOps Prototyping
16 hours, 50 minutes ago

You're on a roll! Sign up now to keep applying.

Sign Up

Already have an account? Log in

Used by 14,729+ remote workers