Sr. Director Product - Expert Claims Review

Zelis Healthcare, LLC; Morris Township (NJ); Hybrid; USD 185,000 - 235,000; Full time

Job summary

Zelis is seeking a Senior Director of Product, Expert Claims Review (ECR) to lead product management across the ECR portfolio, including DRG Review, Clinical Chart Review, and Itemized Bill Review, as well as retrieval features within Payment Integrity. You will translate strategy into coordinated roadmaps, establish priorities, guide investment decisions, and develop Product Managers and Owners.

The role partners with Operations, Technology, Sales, and executive leadership to deliver measurable

Qualifications

• Bachelor's degree in a related field, or commensurate experience.
• 10+ of product management, healthcare technology, payment integrity, or related experience.
• 5+ years of leadership experience managing product or comparable teams.
• Demonstrated experience managing a portfolio of complex healthcare products or services.
• Demonstrated experience leading enterprise change and influencing senior stakeholders in a matrixed environment.
• Strong knowledge of healthcare claims, reimbursement, clinical review, or payment integrity processes.
• Experience developing product roadmaps, evaluating investments, and managing products throughout their lifecycle.
• Experience evaluating or implementing AI, automation, analytics, or decision-support capabilities in a regulated environment.
• Demonstrated ability to work with executive leaders, clients, technical teams, and operational organizations.
• Strong financial, analytical, communication, and decision-making skills.
• Experience operating effectively in a matrixed organization.

Responsibilities

• Lead product management for the ECR product areas.
• Translate enterprise and Payment Integrity strategy into coordinated portfolio priorities and product plans.
• Establish portfolio objectives and ensure roadmaps support broader business goals.
• Evaluate client needs, market conditions, regulatory developments, operational requirements, and technology opportunities when setting priorities.
• Identify opportunities to expand product value, improve market competitiveness, and strengthen client outcomes.
• Guide decisions regarding product investment, modernization, enhancement, integration, and retirement.
• Ensure dependencies across the ECR portfolio are identified and effectively managed.
• Create clarity in complex situations and align leaders around enterprise priorities.
• Lead transformation initiatives across Product, Operations, and Technology.
• Build, coach, and develop Product Managers, Product Owners and Business Analysts.
• Foster a culture of accountability, transparency, and continuous improvement.
• Influence senior leaders across a matrixed organization without direct authority.
• Identify and remove organizational barriers to product performance.
• Review and approve product roadmaps, investment recommendations, and major releases.
• Establish governance, planning cadences, and performance reporting.
• Maintain understanding of payer needs and reimbursement trends.
• Engage with strategic clients and prospects to understand business challenges and product needs.

Skills

Product leadership

Healthcare technology

Strategic thinking

Stakeholder management

Education

Bachelor's degree in related field

Job description

At Zelis, we Get Stuff Done. So, let's get to it!

A Little About Us

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients.

At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.

A Little About You

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

Position Overview

The Sr. Director of Product, Expert Claims Review (ECR) is responsible for leading product management across Zelis' Expert Claims Review and Data Mining portfolio, including Diagnosis-Related Group (DRG) Review, Clinical Chart Review (CCR), Itemized Bill Review (IBR), and supporting features like our Document Retrieval functions within Zelis' Payment Integrity business. This leader translates the broader Payment Integrity strategy into coordinated product plans across the ECR portfolio. The Senior Director establishes portfolio priorities, oversees product roadmaps, guides investment recommendations, and ensures Product Managers and Product Owners are aligned around customer needs, business objectives, and operational requirements. The role works closely with Payment Integrity Operations leadership, Technology, Sales/Client Management, executive leadership and other key stakeholders. Success requires strong healthcare product leadership, payment integrity knowledge, sound commercial judgment, and the ability to lead effectively within a complex matrixed organization. The role is also responsible for developing product leadership capability, strengthening succession pipelines, and advancing the responsible use of AI and automation across the ECR portfolio.

What You'll Do

Portfolio Leadership

• Lead product management for the ECR product areas.
• Translate enterprise and Payment Integrity strategy into coordinated portfolio priorities and product plans.
• Establish portfolio objectives and ensure individual product roadmaps support broader business goals.
• Evaluate client needs, market conditions, regulatory developments, operational requirements, and technology opportunities when setting priorities.
• Identify opportunities to expand product value, improve market competitiveness, and strengthen client outcomes.
• Guide decisions regarding product investment, modernization, enhancement, integration, and retirement.
• Ensure dependencies across the ECR portfolio are identified and effectively managed.

Leadership and Organizational Capability

• Create clarity in complex or ambiguous situations and align leaders around enterprise priorities, tradeoffs, and intended outcomes, while promoting consistent product lifecycle management practices across the portfolio.
• Lead transformation initiatives across Product, Operations, and Technology while balancing short-term execution with long-term portfolio value.
• Build, coach, and develop Product Managers, Product Owners and Business Analysts alike, including talent planning and leadership development.
• Foster a culture of accountability, transparency, sound judgment, continuous improvement, and responsible experimentation.
• Influence senior leaders across a matrixed organization without relying on direct authority.
• Identify and remove organizational barriers that limit product performance, speed, scalability, or customer value.
• Review and approve product roadmaps, investment recommendations, business cases, and major release plans.
• Establish clear accountability between portfolio strategy, product roadmap ownership, and Agile delivery execution.
• Establish product governance, planning cadences, and performance reporting.

Customer and Market Leadership

• Maintain an understanding of payer needs, healthcare reimbursement trends, competitive offerings, and emerging payment integrity capabilities.
• Engage with strategic clients and prospects to understand business challenges and product needs.
• Partner with key stakeholders on product positioning, client presentations, requests for proposals, and strategic growth opportunities.
• Represent the ECR portfolio in executive client discussions and internal leadership forums.
• Ensure client requests are evaluated consistently against strategic fit, market applicability, operational impact, and expected return.

Business and Product Performance

• Establish portfolio-level measures for revenue, savings performance, adoption, client satisfaction, operational efficiency, quality, and product health.
• Monitor portfolio results and direct corrective action where performance does not meet expectations.
• Partner with Finance and business leadership on annual planning, forecasting, budgeting, and investment analysis.
• Review business cases for material product investments and recommend priorities to executive leadership.
• Ensure product decisions account for implementation complexity, operational scalability, technical sustainability, and financial impact.

AI and Innovation Leadership

• Establish priorities for the responsible use of AI, automation, and advanced analytics across the ECR portfolio.
• Partner with key stakeholders to ensure AI-enabled capabilities are accurate, explainable, compliant, and operationally sustainable.
• Sponsor business cases and investment recommendations for AI-enabled product improvements.
• Define governance expectations for AI-assisted workflows, including human oversight, validation, monitoring, escalation, and performance measurement.
• Promote appropriate adoption of AI-enabled tools within the Product organization to improve research, analysis, documentation, planning, and decision-making.
• Monitor market developments in AI and healthcare technology and assess their relevance to the ECR portfolio.

Cross-Functional Leadership

• Partner closely with Operations leadership to ensure products can be delivered consistently, efficiently, and at scale.
• Collaborate with keys senior leaders to ensure product capabilities are accurate, defensible, and technically feasible.
• Align with Implementation and Client Management teams regarding client readiness, product changes, and adoption.
• Escalate and resolve cross-functional issues that affect product performance or portfolio delivery.
• Sponsor major product transformation and modernization initiatives.
• Support change management, release readiness, and communication for significant portfolio changes.

What You'll Bring to Zelis

• Bachelor's degree in a related field, or commensurate experience.
• 10+ of product management, healthcare technology, payment integrity, or related experience.
• 5+ years of leadership experience managing product or comparable teams.
• Demonstrated experience managing a portfolio of complex healthcare products or services.
• Demonstrated experience leading enterprise change and influencing senior stakeholders in a matrixed environment.
• Strong knowledge of healthcare claims, reimbursement, clinical review, or payment integrity processes.
• Experience developing product roadmaps, evaluating investments, and managing products throughout their lifecycle.
• Experience evaluating or implementing AI, automation, analytics, or decision-support capabilities in a regulated environment.
• Demonstrated ability to work with executive leaders, clients, technical teams, and operational organizations.
• Strong financial, analytical, communication, and decision-making skills.
• Experience operating effectively in a matrixed organization.

Preferred Qualifications

• Master's degree or MBA.
• Direct experience with solutions in the ECR portfolio.
• Experience with pre-payment and post-payment integrity solutions.
• Experience modernizing technology-enabled healthcare services.
• SAFe, Pragmatic Institute, Product School, or comparable product management certification.
• Understanding of responsible AI principles, including governance, explainability, privacy, human oversight, and performance monitoring.

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies.

While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule.

Base Salary Range

$185,000.00 - $234,650.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

Equal Employment Opportunity

Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email [e-mail].

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.