Note: The job is a remote job and is open to candidates in USA. Humana Inc. is a leading U.S. healthcare company seeking a strategic and execution-focused Lead Product Manager to drive initiatives within the Claims Administration and Payment Integrity organization. The role involves coordinating collaboration across products to improve claims audit processes and deliver measurable business value.
Responsibilities
- Define and own the vision, strategy, and roadmap for the interconnectedness of CAPI solutions including vendor integration and backend support, aligned with organizational goals and regulatory requirements
- Translate business needs into clear product capabilities and deliverables, focused on how existing products (including internal and vendor-managed) work together
- Prioritize initiatives across claims prepay, postpay, and audit functions to maximize impact on cost avoidance, recovery, and operational efficiency
- Represent the CPI ART in the broader CAPI intake process. Identify and assess impacts to the CPI ART teams and bring those to impacted Product Managers
- Serve as the primary liaison between business stakeholders (claims operations, audit teams, SIU, compliance) and technology teams for your products
- Understand and educate users on impacts to business workflows supporting claims audit operations, including prepay edits, postpay reviews, and recovery processes
- Gather and synthesize feedback from end users to continuously improve product connectivity
- Partner with IT and engineering teams to design, build, implement, and support technology products and platforms including system modernization
- Create and manage detailed product requirements, user stories, and acceptance criteria
- Participate in agile ceremonies, ensuring alignment between business priorities and technical execution
- Oversee product releases, enhancements, and lifecycle management for your CAPI responsibilities
- Drive innovation in claims auditing capabilities, including rule engines, analytics, and automation tools
- Support development of new prepay and postpay strategies to identify fraud, waste, and abuse (FWA)
- Ensure solutions are scalable and adaptable to evolving regulatory and reimbursement environments
- Define and track key performance indicators (KPIs) to measure product success (e.g., savings, accuracy, audit yield, turnaround time)
- Partner with analytics teams to develop reporting and dashboards that demonstrate business value and ROI
- Communicate outcomes and value realization to senior leadership and stakeholders
- Lead cross-functional communication to ensure alignment on priorities, timelines, and outcomes
- Support change management efforts, including training, documentation, and adoption strategies
- Act as an advocate for both business and technology stakeholders
Skills
- Candidate should bring either a) strong SME (subject matter expert) knowledge and experience in payment integrity operations, business processes, and technology products including key vendors, or b) strong product management expertise and a product mindset for delivery
- Must also have experience applying an Agile framework to deliver large scale products in a healthcare environment
- Bachelor's degree in business, Healthcare Administration, Information Systems, or related field
- Experience working with cross-functional teams, including business operations and IT/engineering
- Proven ability to translate complex business needs into scalable technology solutions
- Strong analytical and problem-solving skills with a data-driven mindset
- Experience with Agile methodologies and product management tools
- Experience in payment integrity, claims auditing, or fraud, waste, and abuse (FWA) programs
- Familiarity with claims platforms, rule engines, and audit systems
- Knowledge of healthcare reimbursement models (e.g., Medicare, Medicaid, commercial)
- Experience demonstrating financial impact and ROI of product initiatives
- MBA or advanced degree
Benefits
- Bonus incentive plan
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
Company Overview