Director, Product Management — AI Claims Platform

CB Smart Recruit•New York, NY

19h•Hybrid

About The Position

Our client is a major U.S. healthcare organization operating across healthcare and health insurance services. They are seeking a Director of Product Management – AI Claims Platform to lead a portfolio of AI-powered products supporting complex health insurance claims operations. This is not a generic AI product role. The organization is developing a platform designed to help claims teams review claims more accurately and efficiently by using AI to understand policies, claims data, business rules, and operational workflows and provide decision support around whether claims should be approved, denied, adjusted, or escalated. The platform is currently in an MVP / improvement phase and is not yet fully mature. The successful candidate will therefore need to be comfortable operating with ambiguity, creating structure, and evolving products and requirements as the platform develops. The Director of Product Management will own the broader AI Claims Platform portfolio, which includes: Decision-support tools, Auto-adjudication support, Claims advisor capabilities, Knowledge-base functionality, Policy understanding, Rules-engine enhancements. This is both a strategic and hands-on product leadership role. You will lead Product Managers while remaining directly involved in shaping product strategy, roadmaps, requirements, and product logic. The ideal candidate can translate highly complex healthcare policies and operational workflows into technology products rather than operating solely as a people manager or high-level strategist.

Requirements

Director, Principal Product Manager, Group Product Manager, Lead Director, or comparable senior product leadership experience.
Demonstrated decision-support or workflow-automation product experience.
Experience within payer, claims, health insurance, or another highly complex policy/rules-based workflow environment.
Demonstrated ability to translate policies and business rules into product logic.
Strong executive communication and stakeholder-management capabilities.
Cross-functional experience partnering with Data Science, Engineering, Operations, and Business teams.
Comfortable working in an MVP-stage environment with ambiguity and building structure.
Product experience involving AI/ML, GenAI, LLMs, human-in-the-loop systems, analytics, or automation.
Genuine product ownership, including roadmap and product development responsibility.
Experience owning and shipping products.
Ability to translate complicated healthcare policies and workflows into product logic.
Understanding of decision-support and workflow automation.
Ability to work effectively with healthcare operations stakeholders.
Ability to operate strategically while remaining hands-on with the product.
Experience working across business, operations, Data Science, and Engineering.
Comfortable creating structure in an evolving MVP-stage environment.
Ability to lead Product Managers without becoming removed from day-to-day product ownership.

Nice To Haves

Claims adjudication or auto-adjudication
Rules engines or decision engines
Payer / health insurance operations
Prior authorization
Payment integrity
Provider/member claims
Utilization management
Managing Product Managers or product squads
Building product operating models
AI governance, evaluation, auditability, or human oversight
Consulting experience within payer or healthcare operations
Strong management consulting background combined with payer experience involving claims, digital transformation, AI/analytics, automation, product strategy, or operations transformation.

Responsibilities

Own product strategy and roadmap development across the AI Claims Platform portfolio.
Translate complex healthcare policies, business rules, and operational workflows into product logic and requirements.
Help shape products from the MVP stage through continued improvement and maturity.
Work hands-on with requirements and product decisions while providing broader strategic direction.
Establish structure and product processes in an evolving environment.
Lead products involving AI/ML, analytics, automation, and decision-support capabilities.
Help develop and improve AI-powered recommendations supporting claims operations.
Drive products involving complex rules-based workflows.
Partner with technical teams on AI-enabled product development.
Support products involving human-in-the-loop decision making and operational AI.
Partner closely with claims and healthcare operations stakeholders.
Understand complex claims workflows, policies, and business rules.
Translate operational requirements into scalable product capabilities.
Build credibility with payer and claims stakeholders through a strong understanding of healthcare operations.
Manage an existing team of 2 Product Managers.
Potentially help grow the team by approximately 2 additional Product Managers.
Coach and develop PM talent while remaining actively involved in product ownership.
Help shape the product, roadmap, and requirements rather than functioning solely as a people manager.
Partner closely across: Business Operations, Data Science, Engineering, Claims subject-matter experts.
Communicate effectively with executives and manage stakeholders.
Operate effectively within a complex, cross-functional organization.