Lead Product Manager

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We are seeking a strategic and execution-focused Lead Product Manager to drive innovative new initiatives within the Claims Administration and Payment Integrity (CAPI) organization in the Claims domain. This role is responsible for developing and managing the long-term deployment of new AI-driven solutions - in partnership with business and engineering partners - to help fast-track identification of claims payment anomalies. This person will also ensure coordination between new and existing tools as well as the connections and collaboration across Claims Payment Integrity (CPI) tools and applications. They will be involved in the development, implementation, and continuous improvement of prepay and postpay claim audit processes, enabling operational efficiency, and delivering measurable business value through our products. In addition, this role will represent the CPI ART (Agile Release Train) at CAPI intake meetings, ensuring that impacts to CPI teams are identified and assessed as part of the intake process.

The ideal candidate is a strong cross-functional leader who partners closely with business stakeholders, operations teams, and IT to deliver scalable, high-impact solutions that improve claims accuracy, reduce waste, and optimize compliance. The role is expected to bring structure and influence to help organize and advance the maturity of the CPI ART.

Key Responsibilities

This person will play a critical role in the cross-initiative (intra-ART) execution space but also includes product ownership with measurable outcomes for AI-driven solutions including Claims Control Tower, Provider fingerprinting, and integration of claims audit applications.

Product Connectedness & Enablement

• Develop and manage (with business and engineering partners) the vision, strategy, and roadmap for all AI-driven applications in the Payment Integrity space. Ensure that findings from anomaly detection solutions are matched to existing findings to ensure that either 1) they are scrubbed out of findings presented to users, or 2) they are presented to users, with the outcomes from users fed into existing applications. Ensure that all results are fed back to the large language models (LLM) to ensure continuous learning and advancement of the AI.

• Manage 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.

Business Partnership & Enablement

• Ensure that anomalies are tracking from identification to de-duplication to research to resolution and back to the LLM to enable reporting and business value articulation. Work with architects and engineering to determine the "how."

• Ensure that the user interface for anomaly detection tools is designed, implemented, and continuously improved. Work with architects and engineering to determine where the UI should sit.

• 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 anomaly detection, prepay edits, postpay reviews, and recovery processes.

• Gather and synthesize feedback from end users to continuously improve anomaly detection and product connectivity.

Technology Delivery & IT Collaboration

• Partner with IT and engineering teams to design, build, implement, and support technology products and platforms.

• 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.

Payment Integrity Optimization

• 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.

Data & Value Realization

• 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.

Stakeholder Communication & Change Management

• 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.

Use your skills to make an impact

Required Qualifications

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 is desired.

• 5+ years of Product Management experience, specifically leading design and development of software, data, or analytics products including roadmap development and management, results tracking, stakeholder and user relationship management and communication, investment cost justification, etc.

• 3+ years of Agile experience, specifically leading development and delivery of solutions that enable business value including use of tools like Jira, Jira Align, ADO (Azure Dev Ops), etc. and involvement in Agile ceremonies.

• 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

Preferred Qualifications

• Experience managing vendor relationships

• 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

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$126,300 - $173,700 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

Application Deadline: 07-31-2026

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at?Humana.com?and at?CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our