We are seeking a strategic and execution-focused Lead Product Manager to drive initiatives within the Claims Administration and Payment Integrity (CAPI) organization in the Claims domain. This role is responsible for coordinating the connections and collaboration across Claims Payment Integrity (CPI) products involved in the development, implementation, and continuous improvement of prepay and postpay claim audit processes, enabling operational efficiency, and delivering measurable business value. 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 solutions including automation, feeds, and modernization efforts.
Product Connectedness & Enablement
- 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.
Business Partnership & Enablement
- 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
Technology Delivery & IT Collaboration
- 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
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
- 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
Preferred Qualifications
- 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: 07-03-2026
