Sr. Product Manager- Payment Integrity

Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse. As Sr. Product Manager-Payment Integrity, you’ll be responsible for managing Payment Integrity products, driving the strategy and execution for the product suite while collaborating with various teams to deliver scalable solutions.

Responsibilities:

• Own the product roadmap for Data Mining and Complex Claim Audit management products
• Lead customer discovery with health plan audit teams, claims operations leaders, and clinical reviewers - going beyond surface-level requests to uncover generalizable workflow needs
• Define product requirements across audit types (e.g., DRG validation, clinical validation, itemized bill review, data mining concepts), identifying common platform patterns while accounting for audit-type-specific logic
• Shape the GenAI-powered medical record review experience, making critical product decisions about what to automate, where human judgment is essential, and how to design auditor-in-the-loop workflows
• Collaborate with engineering and data science teams to deliver high-quality products, providing the domain context they need to build effectively
• Partner with clinical SMEs and auditors to validate requirements, test assumptions, and ensure domain accuracy
• Drive go-to-market readiness working with sales, marketing, and implementation teams on positioning, enablement, and launch
• Make principled trade-off decisions - resisting one-off customization requests in favor of scalable, configurable product solutions that serve the broader market
• Manage the Codoxo Payment Integrity products and ensure they meet the defined success metrics
• Work closely with Codoxo data science, product engineering, customers, customer success, and Codoxo payment integrity experts to define and execute the roadmap for payment integrity products
• Support product marketing to create content for internal and external stakeholders

Requirements:

• Bachelor's in Engineering, Computer Science, technical related field, or equivalent practical experience
• 5+ years of professional experience in payment integrity, claims auditing, or claims operations - as a product manager, auditor, audit manager, solutions architect, or operations leader
• 3+ years in a Product Management role at a B2B SaaS or healthcare technology company, with direct ownership of roadmap, backlog, and delivery working alongside engineering teams
• Working knowledge of multiple audit types with an understanding of how claims are identified for audit, how medical records are reviewed, and how findings are documented and recovered
• Experience building or contributing to products that scale - you can point to examples where you turned domain-specific knowledge into configurable, platform-level product capabilities rather than customer-specific features
• Comfort working with AI/ML-powered products - you don't need to be a data scientist, but you can reason about automation vs. human review trade-offs, provide feedback on model outputs, and design workflows where AI and human expertise complement each other
• Strong customer discovery and stakeholder management skills - you can lead a conversation with a VP of Payment Integrity and an audit nurse with equal confidence, and translate what you learn into clear product direction
• Proven experience in gathering and prioritizing product requirements into a meaningful product roadmap
• Experience with Agile software methods
• A learning and growth mindset with an ability to self-start on problems, a willingness to own problems, and a desire to make things better
• You must demonstrate a strong product sense and have experience working with design teams
• You can lead without giving orders and argue a viewpoint persuasively
• You can write, speak, and think about complicated and highly technical problems with lucidity
• Physical Requirements: Work is performed in an office environment (either in our office or work-from home) and requires the ability to work on a computer, operate standard office equipment, and work at a desk
• Prior hands-on operational experience in claims or auditing before transitioning to a product or technology role - former auditors, audit team leads, or claims operations managers who moved into product bring invaluable workflow intuition
• Experience managing products at different lifecycle stages simultaneously - maintaining and growing a mature product while launching a new one
• Familiarity with clinical documentation, medical coding, and classification systems (ICD-10, CPT, DRG grouping, medical record abstraction)
• Understanding of health plan IT ecosystems - claims adjudication platforms, EDI transactions (835/837), provider data, and how audit workflows integrate with core administrative systems
• Experience working directly with data science or machine learning engineering teams on products that involve model-generated outputs reviewed by human users
• Prior experience with analytics, healthcare payment integrity or revenue cycle management products is a plus
• Proven record of product management accomplishments with demonstrated market success