Healthcare Product Manager - AI/ML

Job Requirements

Primary Responsibilities

Golden Dataset Claim Scenario CreationGenerate test claims as a Payer and Adjudication Subject Matter Expert to support agentic AI solution evaluations, both for internal support functions and governanceGenerate files to simulate and support Payer Operations AI solutions both for internal support and governance Identify or construct representative claim scenarios aligned to business and product requirements, then de-identify and modify data as needed

Translate product requirements into scalable testing files covering both core functionality and edge casesAdjudication Outcome DeterminationManually apply benefit and adjudication rules to create expected outcomes aligned with the scope and data sources of each agentic solutionValidation of simulated payer files

Determine allow/reject determinations with clearly supporting rationale and calculate financial impacts and member responsibilityEnsure citation and traceability of determination logic so outcomes can be defended in review Structured Output Generation QACreate structured outputs X12 JSON Excel and answer keys to support agent testing and evaluationPerform quality assurance on generated files and outcomes to ensure accuracy and consistencyContribute to standardizing adjudication logic and reasoning so outputs are consistent and repeatable across scenarios

Required Qualification 5+ years of experience in product management claims operations, or payer testing/QA rolesStrong payer domain knowledge including claims benefits prior authorization and policy/editing logicDirect experience with operational pain points such as denials, call center burden and configuration complexityHands-on experience with AI/ML-driven products including defining use cases and working with data/engineering teamsAbility to manually apply adjudication and benefit rules to determine accurate claim outcomesComfort working with structured data formats and QA processesPreferred QualificationsExperience supporting model testing, agent evaluation or AI governance/review board processesFamiliarity with agentic AI systems or LLM-based automation in a healthcare/payer contextExperience building or QA-ing test data answer keys or validation scenarios at scaleWorking knowledge of Excel-based output generation and data QA toolingX12 Claims Experience Payer Operation file experience Work Experience 7-10Years

Pay: $60.00 - $65.00 per hour

Expected hours: 40.0 per week

Experience

• Health Care domain: 5 years (Required)
• Payer and Adjudication Subject Matter Expert : 5 years (Required)
• Agentic AI or LLM: 3 years (Required)
• agent evaluation or AI governance: 3 years (Required)

Work Location: Remote