Senior Director, AI-Driven Risk & Quality for Payers

Innovaccer Inc.; United States; Hybrid; USD 180,000 - 260,000; Full time

Benefits offered by this job

Generous Paid Time Off

Best-in-Class Parental Leave

Recognition & Rewards

Comprehensive Insurance Coverage

Job summary

Innovaccer Inc. is seeking a Senior Director of Product Management – Risk & Quality to own strategy across Risk Adjustment, RADV/Audit, Quality, and Compliance products.

Lead an AI-first roadmap and ensure regulatory agility to differentiate in CMS/HHS landscapes for health plan partners. You will partner with senior leaders to shape the Payer product narrative, drive revenue targets, and guide a cross-functional team including Engineering, Data Science, and Clinical SMEs to deliver scalable

Qualifications

• Experience: 10+ years in Product Management or related technology leadership roles, with at least 5+ years of direct experience building and scaling Risk Adjustment, RADV/Audit, or Quality solutions for health plans/payers.
• Domain Mastery: Deep expertise in Risk Adjustment methodologies (CMS-HCC, RxHCC, HHS-HCC), coding workflows (ICD-10, MEAT criteria), retrospective chart reviews, prospective point-of-care nudges, and RADV audit prep.
• AI & Data Fluency: Proven track record of shipping AI/ML capabilities into healthcare workflows (e.g., NLP for unstructured clinical documentation, predictive suspecting models, generative summaries for coders).
• Enterprise Scale: Demonstrated success in shipping and embedding SaaS products within complex payer environments and multi-payer enterprise systems.
• People Leadership: Strong track record of hiring, mentoring, and scaling high-performing product management teams while fostering a culture of ownership and AI adoption.
• Communication & Influence: Exceptional memo-writing and executive presentation skills; comfortable discussing risk models with actuaries, NLP accuracy with data scientists, and ROI with CFOs.
• Education: Bachelor’s degree in Computer Science, Health Informatics, Business, or related quantitative field required; Master’s/Advanced degree preferred.

Responsibilities

• Own the multi-year product strategy for Risk Adjustment, RADV Audit Management, Risk Analytics, and integrated Quality/HEDIS products.
• Lead AI-native product roadmap leveraging NLP, LLMs, and automated chart retrieval/coding engines.
• Stay ahead of CMS, HHS, and state regulatory landscapes to ensure continuous product compliance and market differentiation.
• Partner with VP Payer, CPO, and Market President- Payer Growth to shape the overall Payer product narrative and co-own revenue targets for your products.
• Direct and develop product managers to unify risk analytics, suspecting, chart review, coding workflows, and audit trail tools into a single, seamless product experience.
• Enforce an AI-first development lifecycle—from discovery and automated feedback synthesis to generative prototyping and intelligent backlog management.
• Delivery & Quality: Partner closely with Engineering, Data Science, Clinical SMEs, and Platform teams to build scalably on Innovaccer's Healthcare Intelligence Cloud, maintaining a predictable release cadence.
• Impact & ROI Metrics: Establish strict outcome-based success metrics (e.g., chart review accuracy, suspecting yield rates, RADV audit mitigation rate, coding velocity) and track customer value realization.
• Executive SPOC: Build direct relationships with plan executives (CMOs, Chief Risk Officers, Actuarial Leads, VPs of Risk Adjustment) to understand operational pain points and serve as the product authority for strategic discussions and escalations.
• GTM Enablement & Revenue Co-Ownership: Collaborate with Sales, Pre-Sales, and Customer Success to refine sales pitches, participate in key customer pursuits, support upsell/cross-sell initiatives, and validate product-market fit.
• Industry Representation: Represent Innovaccer’s Risk Adjustment perspective in external forums, industry advisory boards, and regulatory consultations.

Skills

Product Management

Leadership

AI/ML in healthcare

Risk Adjustment domain

Payer/Health insurance

SaaS product delivery

Regulatory compliance

Executive communication

Education

Bachelor’s degree in Computer Science, Health Informatics, Business, or related quantitative field

Master’s/Advanced degree preferred

Job description

About the Role

Reporting to executive leadership, the Senior Director of Product Management – Risk & Quality is a key leader within Innovaccer’s Payer vertical. In this role, you will hold end-to-end accountability for the product strategy, roadmap, and go-to-market (GTM) execution across our Risk Adjustment, RADV/Audit Readiness, Quality (HEDIS/Stars), and Compliance solution portfolio.

We are looking for a seasoned product leader who possesses deep domain expertise in clinical and financial risk operations across Commercial (ACA), Medicare Advantage, and Managed Medicaid markets. You will translate complex regulatory requirements, coding workflows, and risk-capture dynamics into a market-leading, AI-native product platform that drives verifiable revenue accuracy, audit defensibility, and operational efficiency for our health plan partners.

A Day in the Life

1. Product Strategy & Domain Leadership (Risk & Quality)

• End-to-End Portfolio Vision: Own the multi-year product strategy for Risk Adjustment (Prospective, Concurrent, and Retrospective), RADV Audit Management, Risk Analytics, and integrated Quality/HEDIS products.
• AI-First Innovation: Translate market needs into an AI-native product roadmap—leveraging NLP, LLMs, and automated chart retrieval/coding engines to eliminate manual touchpoints and maximize risk accuracy.
• Regulatory Agility: Stay ahead of evolving CMS, HHS, and state regulatory landscapes (e.g., V28 model updates, RADV audit rule changes, submission deadlines) to ensure continuous product compliance and market differentiation.
• Strategic Alignment: Partner with VP Payer, CPO, and Market President- Payer Growth to shape the overall Payer product narrative and co-own revenue targets for your products.

2. Execution, Architecture & AI-Native Product Craft

• Harmonized Suite: Direct and develop product managers to unify risk analytics, suspecting, chart review, coding workflows, and audit trail tools into a single, seamless product experience.
• AI-Native Operational Rigor: Enforce an AI-first development lifecycle—from discovery and automated feedback synthesis to generative prototyping and intelligent backlog management.
• Delivery & Quality: Partner closely with Engineering, Data Science, Clinical SMEs, and Platform teams to build scalably on Innovaccer's Healthcare Intelligence Cloud, maintaining a predictable release cadence.
• Impact & ROI Metrics: Establish strict outcome-based success metrics (e.g., chart review accuracy, suspecting yield rates, RADV audit mitigation rate, coding velocity) and track customer value realization.

3. Customer, GTM & Market Engagement

• Executive Single Point of Contact (SPOC): Build direct relationships with plan executives (CMOs, Chief Risk Officers, Actuarial Leads, VPs of Risk Adjustment) to understand operational pain points and serve as the product authority for strategic discussions and escalations.
• GTM Enablement & Revenue Co-Ownership: Collaborate with Sales, Pre-Sales, and Customer Success to refine sales pitches, participate in key customer pursuits, support upsell/cross-sell initiatives, and validate product-market fit.
• Industry Representation: Represent Innovaccer’s Risk Adjustment perspective in external forums, industry advisory boards, and regulatory consultations.

What You Need

• Experience: 10+ years in Product Management or related technology leadership roles, with at least 5+ years of direct experience building and scaling Risk Adjustment, RADV/Audit, or Quality solutions for health plans/payers.
• Domain Mastery: Deep expertise in Risk Adjustment methodologies (CMS-HCC, RxHCC, HHS-HCC), coding workflows (ICD-10, MEAT criteria), retrospective chart reviews, prospective point-of-care nudges, and RADV audit prep.
• AI & Data Fluency: Proven track record of shipping AI/ML capabilities into healthcare workflows (e.g., NLP for unstructured clinical documentation, predictive suspecting models, generative summaries for coders).
• Enterprise Scale: Demonstrated success in shipping and embedding SaaS products within complex payer environments and multi-payer enterprise systems.
• People Leadership: Strong track record of hiring, mentoring, and scaling high-performing product management teams while fostering a culture of ownership and AI adoption.
• Communication & Influence: Exceptional memo-writing and executive presentation skills; comfortable discussing risk models with actuaries, NLP accuracy with data scientists, and ROI with CFOs.
• Education: Bachelor’s degree in Computer Science, Health Informatics, Business, or related quantitative field required; Master’s/Advanced degree preferred.

We offer competitive benefits to set you up for success in and outside of work.

Here’s What We Offer

• Generous Paid Time Off: Recharge and relax with 20 days of fixed time off per year, in addition to company holidays—because we believe work-life balance fuels performance.
• Best-in-Class Parental Leave: Spend quality time with your growing family. We offer one of the industry’s most generous parental leave policies to support you during life’s most important moments.
• Recognition & Rewards: We celebrate wins—big and small. Get rewarded with monetary incentives and company-wide recognition for your impact and dedication. Your hard work won’t go unnoticed.
• Comprehensive Insurance Coverage: Stay covered with medical, dental, and vision insurance, plus 100% company-paid short- and long-term disability and basic life insurance. Optional perks include discounted legal aid and pet insurance.

Innovaccer Inc. is an equal opportunity employer. We celebrate diversity and are committed to fostering an inclusive workplace where all employees feel valued and empowered regardless of any characteristic protected by federal, state or local law including, without limitation, race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, medical condition, disability, age, marital status, or veteran status. Innovaccer Inc. participates in the E-Verify program to confirm employment eligibility of all newly hired employees based out of the U.S. and employed by Innovaccer Inc.

For any additional information, please visit the below websites:

E-Verify

Right to Work (English)

Right to Work (Spanish)