Product Owner

We are seeking an innovative, tech-forward Product Owner with deep expertise in Payment Integrity and a working knowledge of Medicare and Medicaid claim adjudication to join our healthcare payer product team. In this role, you will lead the vision and execution for solutions that prevent, detect, and recover improper medical payments, claims leakage, and fraud across government-sponsored programs. You will combine your domain knowledge with a technical background and hands‑on experience using AI coding and productivity tools (such as Windsurf, GitHub Copilot, etc.) to accelerate delivery, generate technical specs, and optimize the product lifecycle. If you have a proactive go‑getter attitude and want to revolutionize payment integrity through modern technology, we want to hear from you. Key Responsibilities Payment Integrity Strategy & Roadmap: Own and drive the end‑to‑end product roadmap for payment integrity solutions—including pre‑pay/post‑pay claims editing, coordination of benefits (COB), subrogation, DRG validation, and fraud, waste, and abuse (FWA) detection for Medicare and Medicaid populations. AI‑Powered Technical Specification: Utilize AI development tools (Windsurf, GitHub Copilot) to help generate, draft, review, and update technical specifications, bridging complex payment rules, adjudication logic, and developer implementation. Backlog Management & Refinement: Collaborate closely with Business Systems Analysts (BSAs) and engineering teams to translate intricate reimbursement policies, CMS guidelines, and business problems into well‑refined user stories and acceptance criteria. Cross‑Functional Alignment: Partner with clinical reviewers, Special Investigation Units (SIU), data science, and engineering teams to ensure accurate post‑adjudication rules and compliance with healthcare regulations. Workflow Optimization: Champion modern software development practices by leveraging AI assistant tools to improve technical documentation quality, speed up rule configuration, and increase team velocity. Required Qualifications & Skills Domain Expertise: 3+ years of product experience specifically within Healthcare Payer Payment Integrity , claims auditing, or FWA, coupled with a solid working knowledge of Medicare and Medicaid claim adjudication , coding guidelines (ICD‑10, CPT/HCPCS), medical necessity rules, and fee schedules. AI Tool Proficiency: Hands‑on experience working with AI coding and productivity tools (e.g., Windsurf, GitHub Copilot , or similar LLM assistants) to streamline technical workflows and documentation. Technical Background: A solid technical foundation enabling you to understand complex claims processing engines, rules engines, data pipelines, and database schemas. Core Product Skills: Proven track record of defining product roadmaps, translating ambiguous business problems into structured features, and working alongside BSAs to groom backlogs. Mindset: A high‑energy go‑getter attitude with a proactive approach to problem‑solving, comfort with rapid iteration, and a passion for emerging technologies. About Us Moodys NWC is a result‑driven management consulting firm headquartered in the Seattle metropolitan area. We specialize in best‑fit consulting based on client needs, with a focus on all aspects of digital product management. We have an active role that we are looking to assist our premier client with and are looking for an experienced consultant with the right set of values. For us, personality fit is paramount. We are looking for self‑starters who are experienced but flexible in their approach and have a customer‑focused outlook. Our consultants go above and beyond, focus on the end goal, and do what it takes to deliver the desired results. Our compensation reflects the cost of labor across several US geographic markets. The salary for this position ranges from $110,000 in our lowest geographic market up to $140,000 in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on job‑related knowledge, skills, and experience. Other forms of compensation are offered in the form of medical, vision, and dental benefits. Moodys NWC believes in a culture of diversity, acceptance, and belonging. We are committed to being an equal opportunity employer and hiring without discrimination, including based on race, color, creed, national origin, sex, marital status, age, sexual orientation, gender identity, disability, medical status, or veteran status. Moodys NWC complies with federal and state disability laws and makes reasonable accommodations for applicants and candidates with disabilities. #J-18808-Ljbffr