Senior Product Owner / Product Manager – Clinical Claims Data Products

To Apply for this Job Click Here

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.

To Apply for this Job Click Here