Senior Product Owner / Product Manager – Clinical Claims Data Products

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Remote / $70 - $75 hour

INFO

Salary

RATE:

$70 - $75

Location

LOCATION

Remote

Job Type
JOB TYPE

Contract

Senior Product Owner / Product Manager - Clinical Claims Data Products

  • $70-$75 per hour
  • Remote but must be US based
  • Initial 6-9 month contract

This is an opportunity to play a key role in modernising clinical claims data products for healthcare payer organisations. You will work at the intersection of claims analytics, medical groupers, payer operations, and AI-driven product innovation, helping stakeholders improve the transparency, governance, and business value of clinical claims classification frameworks.

The Company

They are a global analytics and AI consultancy that partners with enterprise organisations to solve complex business challenges through data, technology, and advanced analytics. Their healthcare practice supports payer clients with large-scale transformation initiatives across claims, clinical analytics, data products, and operational decision-making. You will join a collaborative environment that combines healthcare domain expertise with modern data and AI capabilities.

The Role and Deliverables

  • Lead discovery workshops with business, clinical, actuarial, claims operations, compliance, analytics, and technology stakeholders to understand current claims classification and grouper workflows.
  • Translate business and clinical requirements into BRDs, user stories, process maps, business rules, acceptance criteria, and validation documentation.
  • Define requirements for clinical claims data products covering inpatient, outpatient, professional, ancillary, and pharmacy claims.
  • Support baseline-to-target comparisons, variance analysis, business impact assessments, UAT planning, and migration readiness activities.
  • Partner with data engineering, analytics, and AI/ML teams to define data mappings, quality standards, validation rules, and product requirements.
  • Drive stakeholder alignment, governance processes, adoption readiness, and production transition planning for modernised claims data products.

Your Skills & Experience

  • Strong experience within healthcare payer claims, claims analytics, medical economics, actuarial analytics, payment integrity, clinical coding, or healthcare data product delivery.
  • Deep understanding of medical groupers, claims classification methodologies, service category logic, claims editing, or payer claims rule frameworks.
  • Knowledge of healthcare claims and coding concepts including ICD-10, CPT, HCPCS, DRG, APC, modifiers, revenue codes, place of service, and 837/835 transactions.
  • Ability to assess how claims classification impacts cost and utilisation reporting, provider analytics, value-based care, risk adjustment, actuarial reporting, and total cost of care analysis.
  • Experience creating business requirements, process maps, decision tables, source-to-target mappings, testing documentation, and validation frameworks.
  • Strong stakeholder management and workshop facilitation skills across clinical, actuarial, operational, compliance, analytics, and technology teams.
  • Familiarity with platforms or methodologies such as Milliman, MedInsight, Solventum/3M, Optum, Cotiviti, CMS grouping logic, DRG/APC workflows, or similar healthcare claims solutions.
  • Experience working alongside engineering, data, and AI/ML teams to deliver healthcare data products and analytics solutions.

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