Jobs and Careers

Senior Assistant Vice President - Healthcare Claims AI - Technical Product Leader

United States, United Statesfull_timeVerifiedPosted 10 Jun 2026

About the role

Healthcare Claims AI / Technical Product Leader to own the vision, strategy, and delivery of AI-powered products and solutions across the healthcare claims lifecycle. This role sits at the intersection of product strategy, AI engineering leadership, and healthcare claims domain expertise—spanning claims adjudication, claims adjustment, payment integrity (PI), coordination of benefits (COB), subrogation, provider dispute resolution, and fraud/waste/abuse (FWA) detection.

You will lead cross-functional teams to architect, build, and operationalize Agentic AI and Generative AI solutions that create measurable value—reducing claims processing costs, accelerating adjudication turnaround, improving payment accuracy, strengthening audit outcomes, and modernizing provider operations workflows. This is a high-visibility leadership role ideal for someone passionate about combining technology, healthcare claims depth, and design thinking to create lasting business impact for national payers.

AI Product Strategy & Roadmap Ownership

Define, own, and evolve the AI product roadmap for healthcare claims solutions—spanning claims adjudication automation, claims adjustment, payment integrity, COB/subrogation, provider issue resolution, and FWA detection.

Translate complex claims operational challenges into AI-first product strategies with clear business cases, ROI frameworks, and measurable KPIs (e.g., auto-adjudication rate, denial accuracy, overpayment recovery yield).

Drive solutions from ideation → POC → MVP → production scale, using agile execution and business-centric prioritization.

Maintain a competitive landscape matrix and continuously benchmark against market players (Optum/Change Healthcare, Cotiviti, Cognizant TriZetto, HealthEdge, Conduent, etc.) to inform differentiation strategy.

Partner with sales, finance, and leadership to determine pricing, packaging, and go-to-market approach (managed services, SaaS, outcome-based/gainshare models).

2. Technical & AI Engineering Leadership

Drive the transition from traditional rules-engine claims processing to AI-augmented adjudication—automating claim edits, benefit configuration interpretation, provider contract parsing, and payment rule application.

Design reusable AI components and platform capabilities (e.g., claims document intelligence, EOB/remittance parsing, provider contract extraction, coding validation engines, browser/desktop automation agents).

Write clear product requirements documents (PRDs), user stories, and technical specifications with well-defined acceptance criteria for engineering teams.

Champion explainability-first AI design, ensuring all models produce audit-ready, evidence-grounded outputs suitable for SIU investigations, CMS audits, and payer compliance reviews.

3. Healthcare Claims Domain & Operational Transformation

Apply deep knowledge of end-to-end claims operations—claim intake, edits, adjudication, pricing, payment, adjustment, appeals, grievances, provider disputes, and overpayment recovery—to identify high-impact AI use cases.

Embed AI solutions into core claims platforms and systems (QNXT, Facets, Amisys, HealthRules Payer, CSC/DXC, etc.) through platform-agnostic integration and API-first design.

Design AI-driven solutions covering pre-pay and post-pay analytics, DRG validation, code editing (CPT/ICD-10/HCPCS), duplicate claim detection, and provider billing pattern analysis.

Build cross-payer intelligence capabilities that leverage anonymized, aggregated claims data to drive payment accuracy benchmarks, denial pattern optimization, and cost-of-care insights.

Support RFP/RFI responses, orals preparation, and executive presentations for national payer pursuits.

Develop AI-powered provider operations solutions—automated provider issue resolution, correspondence generation, contract interpretation, and fee schedule management.

4. Client Engagement & Thought Leadership

Serve as the product spokesperson and AI SME in client engagements—leading executive presentations, POC demonstrations, workshops, and roadmap discussions with CXO/EVP/VP stakeholders at national payers.

Partner with account management and business development teams to shape differentiated claims AI solutions for complex, enterprise-level healthcare pursuits.