Senior Product Manager – Payment Integrity - R01560629

Brillio • St. Louis, MO

23d • $75 - $78

About The Position

The Senior Product Manager – Payment Integrity will lead the strategy, roadmap, and execution for products and capabilities that ensure accurate, compliant, and cost efficient payments across the organization. This role drives initiatives that prevent incorrect payments, improve claims accuracy, optimize reimbursement processes, and enhance overall financial integrity. You will collaborate with engineering, operations, analytics, compliance, and external stakeholders to deliver solutions that reduce payment leakage and improve operational performance.

Requirements

• 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.

Nice To Haves

• 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.

Responsibilities

• 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.
• 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.
• 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.
• 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.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed