Senior Product Owner / Product Manager – Clinical Claims Data Products

Project overview

Senior Product Owner / Product Manager - Clinical Claims Data Products

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

Your Skills & Experience

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

Project details

• Start: flexible
• Duration: 9 month contract
• Remote: remote
• Location: Remote
• Rate: 70-75 EUR/h