Product Capability Manager - AI Transformation, UMR - Remote

UnitedHealth Group•Eden Prairie, MN

9h•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. UMR is seeking Product Capability Manager – AI Transformation to support the design and implementation of Agentic AI solutions transforming healthcare claims operations. These roles will work closely with product leaders, technology teams, and domain experts to translate complex claims processing rules into clear business requirements, AI prompts, decision logic, and operational workflows. The Product Capability Manager will play a critical role in enabling AI-driven capabilities that improve claim adjudication efficiency, payment integrity outcomes, and operational accuracy across multiple AI products. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Requirements

5+ years of experience in healthcare payer operations, healthcare consulting, or healthcare technology delivery
3+ years of experience working with healthcare claims processing including eligibility/benefits, claims edits, coding logic, COB, or pricing
Experience writing business requirements, user stories, functional specifications, and acceptance criteria
Experience collaborating with cross-functional teams including IT, product management, and operations stakeholders
Experience defining or contributing to AI use case strategy, including problem framing, value hypotheses, and measurable success metrics
Experience in creating structured strategies and solution artifacts (e.g., use case briefs, process flows) and integrating models into existing products/capabilities
Experience in PDLC and AIDLC while leveraging modern product management tools – Aha!, JIRA, FIGMA, MIRO, GitHub, etc.
Proven solid analytical skills with the ability to translate complex operational processes into structured requirements
Proven solid written and verbal communication skills
Proven ability to design or operate within AI intake and prioritization frameworks, including evaluating initiatives based on business impact, feasibility, and adoption potential

Nice To Haves

Experience supporting AI, automation, or advanced analytics initiatives within healthcare payer operations
Experience translating policy or clinical guidelines into operational or system rules
Experience working with large payer organizations or TPAs
Experience evaluating and supporting legal, compliance, and risk considerations for AI solutions, including areas such as model governance, responsible AI, and regulatory alignment
Exposure to prompt engineering, rule engines, or decision automation platforms
Knowledge of claims adjudication systems, payment integrity platforms, or healthcare pricing tools
Working knowledge of production AI systems, including MLOps or deployment considerations
Familiarity with Agile development methodologies and product delivery frameworks

Responsibilities

Partner with stakeholders to identify and prioritize AI use cases based on business value
Drive capability vision, strategy, priority and roadmap and engage appropriate enterprise-wide stakeholders to enable awareness and alignment. Own capability backlog and feature/use case prioritization decisions
Define success metrics and measure product and capability performance and own outcomes
Lead product lifecycle management from ideation through deployment and enhancement
Manage the capability and its usage across businesses across the lifecycle, using a defined development process. Drive adoption and value realization of AI-enabled capabilities
Lead detailed requirements gathering and analysis for AI-enabled claims operations initiatives
Translate healthcare claims policies, SOPs, and operational guidelines into structured requirements, decision rules, and AI prompts
Collaborate with Product, IT, Data Science, UX, Clinical, Pricing, and Payment Integrity stakeholders to design AI-assisted claims workflows
Convert complex claims logic (eligibility/benefits, coding edits, modifiers, COB, authorization rules, contract pricing, bundling/unbundling, and recoupment logic) into testable system requirements
Develop detailed user stories, functional specifications, acceptance criteria, and traceability documentation
Support development and refinement of AI agent prompts, decision logic, and rule configurations used in claims automation workflows
Participate in solution design sessions to ensure business logic is accurately represented in system functionality
Support testing, validation, and operational readiness of AI-enabled claims capabilities
Document business processes, operational workflows, and system interactions for new AI-driven capabilities
Collaborate with program leadership to ensure alignment across multiple Agentic AI products and maintain consistency in requirements standards
Serve as the capability champion and apply deep expertise to credibly represent, manage and engage with business(es)
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.