Product Manager, Payment Integrity

At Zelis, we Get Stuff Done. So, let’s get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview The Product Manager, Data Mining Solutions is responsible for leading the product roadmap and lifecycle for Zelis’ developing Payment Integrity Data Mining solution. Working within the strategy and priorities established by executive leadership translates business direction into a clear, actionable roadmap. This role coordinates product planning, requirements, prioritization, release readiness, product performance, and continuous improvement across all key stakeholders. The Product Manager supports the broader business strategy, product vision, portfolio investment strategy, and overall scalability strategy. This role is accountable for ensuring the approved strategy is translated into a well-managed product roadmap and successfully carried through the product lifecycle, including but not limited to major KPIs, revenue requirements and long term P&L growth success. What You’ll Do Product Roadmap and Planning Partner with product leadership, internal stakeholders and external vendors to translate Data Mining strategy and priorities into an actionable product roadmap. Maintain and communicate the roadmap across business, operational, analytics, and technology stakeholders. Develop product plans for new capabilities, enhancements, integrations, workflow improvements, and technical enablement. Prioritize product initiatives based on established strategy, customer and operational needs, expected value, technical feasibility, and resource capacity. Identify dependencies, risks, assumptions, and sequencing requirements associated with roadmap delivery. Recommend roadmap adjustments based on product performance, delivery constraints, stakeholder feedback, and changing business needs. Prepare roadmap materials and product updates for senior stakeholders. Identify opportunities to incorporate AI, machine learning, automation, and advanced analytics into the product roadmap within the strategy and investment direction established by the Vice President. Evaluate proposed AI-enabled enhancements based on customer value, operational impact, data readiness, risk, technical feasibility, and measurable business outcomes. Partner with domain SMEs and key stakeholders to define appropriate human oversight and product requirements for AI-enabled capabilities. Product Lifecycle Management Manage Data Mining capabilities throughout the product lifecycle, from concept evaluation through development, launch, enhancement, maintenance, and retirement. Coordinate the evaluation and definition of proposed product enhancements. Develop business cases and impact assessments for features and improvements within the approved strategic direction. Define expected outcomes, business requirements, success measures, and operational impacts for roadmap initiatives. Ensure product documentation, release information, workflow descriptions, and product requirements remain current. Partner with Operations and Technology to assess product scalability, usability, supportability, and sustainability. Identify opportunities to improve product functionality, user experience, workflow efficiency, and savings performance. Customer and Stakeholder Input Gather and synthesize feedback from key stakeholders, while conducting structured discovery to understand product needs and validate proposed enhancements. Distinguish between client-specific requests and broadly applicable product opportunities. Support roadmap discussions, product demonstrations, and client meetings as needed. Cross-Functional Product Leadership Partner with the product and operational leaders to convert roadmap priorities into features, backlog items, and executable delivery plans. Collaborate with business SMEs to translate data mining concepts into product requirements throughout development. Coordinate with Operations to ensure workflows, staffing, procedures, and training are ready to support new capabilities. Facilitate decisions and resolve issues that span multiple functional teams. Ensure requirements account for data availability, analytics methodology, review processes, client configuration, reporting, and downstream workflows. Release and Adoption Management Coordinate release scope, timing, readiness, communications, and stakeholder alignment on user acceptance testing and launch readiness. Confirm appropriate documentation, training, monitoring, and support processes are in place before release. Monitor adoption and early performance following launch. Identify and coordinate corrective action for product issues, adoption barriers, or unmet requirements. Support product change management across internal teams and clients. Product Performance Track measures such as product adoption, savings opportunity, realized savings, accuracy, review yield, throughput, turnaround time, feature utilization, and customer satisfaction. Analyze performance trends and recommend product enhancements or roadmap changes. Ensure decisions and recommendations are supported by data. Define and monitor product measures for AI-enabled capabilities, including adoption, accuracy, productivity impact, savings performance, exception rates, and user trust. Use AI-enabled tools appropriately to support product research, synthesis, requirements development, reporting, and lifecycle management while ensuring outputs are reviewed and validated. What You’ll Bring To Zelis Bachelor’s degree in a related field, or commensurate with experience. 5+ years of experience in product, business analysis, healthcare technology, or a related discipline. Experience managing a product roadmap and supporting products through the full development lifecycle. Experience translating business needs into product requirements and coordinated delivery plans. Strong stakeholder management, analytical, planning, and communication skills. Experience working in an Agile and/or Kanban product development environment. Ability to influence cross-functional teams without direct authority. Ability to operate effectively in a developing business where processes and capabilities are still being established. Experience supporting AI, machine learning, automation, or analytics-enabled products. Familiarity with responsible AI practices, model monitoring, human-in-the-loop workflows, and AI product governance. Preferred Qualifications Payment Integrity or healthcare claims experience. Experience with data mining, analytics, artificial intelligence, machine learning, or decision-support products. Knowledge of healthcare reimbursement, claims editing, medical coding, clinical review, or fraud, waste, and abuse. Familiarity with SQL/Snowflake, data visualization, or analytics tools. SAFe Product Manager/Product Owner, CSPO, or comparable product certification. Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies. While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule. Base Salary Range $115,000.00 - $145,350.00 Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email View email address on click.appcast.io. Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time. #J-18808-Ljbffr Zelis