UM Product Operations Analyst (Remote)

Availity

1d • Remote

About The Position

This role supports and advances an AI-enabled utilization management (UM) solution that automates and modernizes the prior authorization process for healthcare organizations. The solution is designed to ensure clinical accuracy, regulatory compliance, and operational efficiency by translating complex clinical and payer requirements into structured, scalable logic. The UM Product Operations Analyst manages payer and clinical data, supports software testing, and drives process improvements. This role plays a key part in collaborating across departments to ensure operational excellence. A unique aspect of this position is supporting the testing and evaluation of AI capabilities, specifically Natural Language Processing (NLP) models that leverage clinical concepts. The analyst will help validate model outputs, contribute to annotation and test case development, and provide feedback to improve AI-driven solutions in the healthcare domain. Sponsorship, in any form, is not available for this position.

Requirements

• Advanced proficiency in Excel and general computer skills (Microsoft Office suite).
• Ability to create and execute test strategies, plans, and cases.
• Strong knowledge of healthcare and medical terminology.
• Excellent problem-solving, critical thinking, and attention to detail.
• Ability to work independently and as part of a team.
• Organized, able to multitask, responsible, and proactive.
• Open to giving and receiving feedback.
• Strong written and verbal communication skills, including the ability to communicate complex technical issues to internal and external stakeholders.
• Comfortable with ambiguity and able to design organized approaches to address challenges.
• Ability to take on meaningful responsibility and thrive with limited supervision.

Nice To Haves

• Undergraduate degree is preferable, but applicable experience in a health care setting will be strongly considered in lieu of a degree.
• Prior relevant experience in healthcare or utilization management strongly preferred.
• Experience with AI/NLP model testing or annotation is a plus.
• Experience with bug tracking systems and EMRs is a plus.
• Familiarity with CPT and ICD-10-CM coding, Medicare/Medicaid, and NCD/LCD is beneficial.
• Deep experience in understanding prior auth workflows.
• Client-facing or stakeholder communication experience.
• Advanced Excel Skills

Responsibilities

• Transferring payer and clinical data into internal software systems.
• Creating and executing test strategies, plans, and cases for software and AI/NLP features including creating, maintaining and overseeing customer implementation plans for tree creation.
• Documenting defects using a bug tracking system, test for data accuracy, and participate in quality audits to maintain high standards of technical rigor.
• Reviewing accounts, documenting activity, and ensuring compliance with production goals.
• Collaborating with product and engineering teams to test and validate NLP models using clinical concepts.
• Developing and executing annotation guidelines and test cases for AI features based on complexity and categorization of impact based on products affected.
• Analyzing model outputs, identifying errors, and providing actionable feedback for model improvement.
• Staying current with clinical terminology and best practices in healthcare AI.
• Taking initiative on assigned tasks and special projects with minimal supervision.
• Organizing and prioritizing requests, both internal and external, to help meet established deadlines and often in the context of multiple competing priorities.
• Contributing to process improvement, proactively identifying opportunities to enhance workflows and drive team effectiveness.
• Collaborating with cross-functional teams from clinical, engineering, product, and data science to plan and execute the product roadmap.
• Providing technical support to team members and leads.
• Responding to questions promptly and escalate issues as appropriate.
• Supporting and guiding others to ensure project/process accuracy.

Benefits

• Competitive salary
• Bonus structure
• Generous HSA company contribution
• Healthcare
• Vision
• Dental benefits
• 401k match program
• Unlimited PTO for salaried associates
• 9 paid holidays
• Reimbursement up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
• Education reimbursement
• Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree