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Remote US-hours, mid-level product role with 5+ years increases applicant competition despite niche healthcare specialization.
Role demands deep US payer payment integrity expertise, limiting cross-industry transferability.
Explicit 5+ years PI experience plus domain-specific, client-facing, and technical translation requirements.
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Own the translation of complex payment integrity domain knowledge into technical product capabilities for audits, specifically Complex Clinical Audit (CCA).
Collaborate closely with AI Engineering to develop and validate AI-powered audit workflows, connectors, and product prompts enhancing claims review at scale.
Engage directly with U.S. payer clients to demo product features, explain audit logic and data foundations, and support roadmap and pilot program development across payment integrity domains.
5+ years of hands-on experience in payment integrity within U.S. healthcare payer or vendor settings.
Deep knowledge of U.S. payment integrity programs including pre/post-pay audits, vendor management, savings methodologies, and multiple PI domains like DRG audit and clinical validation.
Experience building or working with technical PI solutions such as backend data workflows, EMR/connector integrations, or user interface systems for claims processing.
Ability to work U.S. Eastern time zone hours and effectively engage with client stakeholders during demos and executive-level conversations.
Strong domain expertise enabling translation of clinical coding guidelines, payer contract language, and audit policies into actionable product logic and AI workflows.
Experienced in client-facing roles with capability to articulate technical and business value to executive-level payers and navigate complex PI environments.
Comfortable leveraging AI tools for prototyping and demonstrating innovative payment integrity solutions in a fast-growing product environment.