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Turning technological disruptions into the advantages. Let's create something Brillian(t) together!
Senior Product Manager – Payment Integrity
Location
Missouri
Posted
112 days ago
Salary
$75 - $78 / hour
Seniority
Senior
Job Description
Senior Product Manager – Payment Integrity
Brillio
• 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.
Job 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.
- 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.
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