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
Scheduled Weekly Hours
40Pay 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.
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: 07-03-2026About 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.
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.
Skills Required
- Strong SME knowledge and experience in payment integrity operations, business processes, and technology products OR strong product management expertise and product mindset for delivery
- 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
- 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
Humana Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Humana and has not been reviewed or approved by Humana.
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Healthcare Strength — Medical, dental, vision, supplemental health, and long-term care insurance are offered alongside on-site/virtual wellness resources and weekly paid well-being time, indicating a whole-person focus.
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Leave & Time Off Breadth — Paid PTO and holidays, volunteer time, and formal leave options such as parental and caregiver time provide broad time-away support. Adoption assistance and lactation rooms extend coverage for key life events.
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Retirement Support — A 401(k) with company match anchors long-term savings. Employer-matched emergency savings programs complement retirement planning.
Humana Insights
What We Do
At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
