AI Transformation Product Manager - Healthcare Ops

UnitedHealth Group; Eden Prairie (MN); À distance; USD 112 700 - 193 200; Plein temps

Résumé du poste

UnitedHealth Group's UnitedHealthcare division seeks a Senior Product Manager - AI Transformation to lead analysis and governance across a portfolio of Agentic AI solutions in UMR Operations, driving AI-enabled claims adjudication improvements and payment integrity. This role offers remote work across the U.S.; Minneapolis or DC office four days per week for local hires.

You will establish requirements frameworks, align AI design with business goals, and deliver measurable value while ensuring

Qualifications

• 8+ years of experience in healthcare payer operations, healthcare consulting, or healthcare technology delivery.
• 5+ years of experience in healthcare claims operations including adjudication, payment integrity, or benefits administration.
• 3+ years leading business analysis teams or complex transformation initiatives.
• Experience leading cross-functional initiatives involving product, IT, operations, and compliance teams.
• Experience in creating structured strategies and solution artifacts and integrating models into existing products/capabilities.
• Experience in PDLC and AIDLC while leveraging modern product management tools - Aha!, JIRA, FIGMA, MIRO, GitHub, etc.
• Demonstrated experience managing enterprise-level requirements strategy and governance.
• Demonstrated experience defining or contributing to AI use case strategy, including problem framing, value hypotheses, and measurable success metrics.
• Deep understanding of healthcare claims processing including eligibility and benefits, coding edits, modifiers, COB, pricing, and adjustments.
• Demonstrated solid stakeholder management and executive communication skills.
• Proven ability to design or operate within AI intake and prioritization frameworks, including evaluating initiatives based on business impact, feasibility, and adoption potential.

Responsabilités

• Lead business analysis strategy and governance across a multi-product Agentic AI portfolio supporting claims operations (First Pass Adjudication, High Dollar Claims, Payment Integrity, Rework Automation, Reverse Quality Engine).
• Establish and standardize requirements frameworks, documentation standards, traceability models, and acceptance criteria across all AI initiatives.
• Align AI solution design with business objectives by collaborating with Product, IT Architecture, Data Science, Clinical, Pricing, Network, Compliance, and Payment Integrity stakeholders.
• Oversee translation of complex claims processing logic into AI-driven rules, prompts, and decision frameworks ensuring regulatory and contractual compliance.
• Manage cross-workstream dependencies, integration points, and delivery sequencing across multiple AI initiatives.
• Implement governance for AI rule libraries, prompt frameworks, and reusable decision components to ensure consistency and scalability across products.
• Partner with a team of capability managers responsible for detailed requirements elaboration and product delivery support.
• Lead through influence to drive portfolio-level consistency and reuse of operational rules and AI decision patterns to accelerate implementation and reduce redundant build efforts.
• Partner with program leadership to track value realization including improvements in cycle time, auto-adjudication rate, payment accuracy, and rework reduction.
• Support stakeholder governance, executive reporting, and operational alignment across business and technology teams.
• Ensure audit readiness, compliance traceability, and documentation for AI-enabled decision processes in claims operations.

Connaissances

Leadership

Cross-functional collaboration

Healthcare payer operations

Healthcare claims operations

AI transformation

Requirements management

AI governance

Stakeholder management

Product management tools

Outils

Aha!

JIRA

FIGMA

MIRO

GitHub

Description du poste

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

UMR, the largest Third-Party Administrator (TPA), a UnitedHealthcare company, is seeking an Senior Product Manager - AI Transformation to lead business analysis and delivery governance across a portfolio of Agentic AI solutions within UMR Operations. This role will provide strategic leadership for requirements management, solution alignment, and cross-functional execution for multiple AI-enabled products focused on improving claim adjudication efficiency, payment integrity, and operational accuracy. The Senior Product Manager will own the operating model for requirements, AI rule governance, and stakeholder coordination across technology, product, clinical, pricing, network, compliance, and payment integrity teams. This leader will partner with a team of consultants responsible for translating complex healthcare claims logic into AI-driven workflows, decision rules, and operational capabilities.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Lead business analysis strategy and governance across a multi-product Agentic AI portfolio supporting claims operations (First Pass Adjudication, High Dollar Claims, Payment Integrity, Rework Automation, Reverse Quality Engine)
• Establishand standardize requirements frameworks, documentation standards, traceability models, and acceptance criteria across all AI initiatives
• Align AI solution design with businessobjectivesby collaborating with Product, IT Architecture, Data Science, Clinical, Pricing, Network, Compliance, and Payment Integrity stakeholders
• Oversee translation of complex claims processing logic into AI-driven rules, prompts, and decision frameworks ensuring regulatory and contractual compliance
• Manage cross-workstream dependencies, integration points, anddeliverysequencing across multiple AI initiatives
• Implement governance for AI rule libraries, prompt frameworks, and reusable decision components to ensure consistency and scalability across products
• Partner with a team of capability manager responsible for detailedrequirementselaboration and product delivery support
• Lead through influence to drive portfolio-level consistency and reuse of operational rules and AI decision patterns to accelerate implementation and reduce redundant build efforts
• Partner with program leadership to track value realization including improvements in cycle time, auto-adjudication rate, payment accuracy, and rework reduction
• Support stakeholder governance, executive reporting, and operational alignment across business and technology teams
• Ensure audit readiness, compliance traceability, and documentation for AI-enabled decision processes in claims operations

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 8+ years of experience in healthcare payer operations, healthcare consulting, or healthcare technology delivery
• 5+ years of experience in healthcare claims operations including adjudication, payment integrity, or benefits administration
• 3+ years of experience leading business analysis teams or complex transformation initiatives
• Experience leading cross-functional initiatives involving product, IT, operations, and compliance teams
• Experience in creating structured strategies and solution artifacts (e.g., use case briefs, process flows) and integrating models into existing products/capabilities
• Experience in PDLC and AIDLC while leveraging modern product management tools - Aha!, JIRA, FIGMA, MIRO, GitHub, etc.
• Demonstrated experience managing enterprise-level requirements strategy and governance
• Demonstrated experience defining or contributing to AI use case strategy, including problem framing, value hypotheses, and measurable success metrics
• Deep understanding of healthcare claims processing including eligibility and benefits, coding edits, modifiers, coordination of benefits (COB), authorization rules, bundling/unbundling, contract pricing, and adjustments
• Demonstrated solid stakeholder management and executive communication skills
• Proven ability to design or operate within AI intake and prioritization frameworks, including evaluating initiatives based on business impact, feasibility, and adoption potential

Preferred Qualifications:

• Experience implementing AI, automation, or decision intelligence solutions within healthcare payer operations
• Experience with payment integrity programs, claims editing platforms, or healthcare pricing systems
• Experience evaluating and supporting legal, compliance, and risk considerations for AI solutions, including areas such as model governance, responsible AI, and regulatory alignment
• Experience working with large payer organizations or third-party administrators
• Knowledge of Agentic AI frameworks, prompt design, or rule-based automation in operational workflows
• Working knowledge of production AI systems, including MLOps or deployment considerations
• Familiarity with Agile or product-based delivery models in enterprise technology environments

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.