Lead Product Manager, Claims Automation

This is a fully remote position, open to applicants in California.

📋 Description

• Lead the product strategy and roadmap for claims automation, encompassing data extraction/entry, enrichment, identification, adjudication, and routing across our claims processing platform.

• Gain expertise in our operational processes and align them with technology and software solutions.

• Identify where AI/ML capabilities (document extraction, classification, sub-classification, routing) should be integrated within the claims pipeline, and determine where logic should remain deterministic and rules-based.

• Create evaluation frameworks for AI product quality—covering accuracy, safety, hallucination risk, auditability, and user trust—and utilize them to make ship/no-ship decisions.

• Develop human-in-the-loop workflows, audit trails, and escalation paths suitable for a regulated financial-transaction system.

• Establish quality and turnaround-time (TAT) metrics for automated and semi-automated claims workflows, and use these metrics to inform ship/no-ship and rollout decisions.

• Evaluate build vs. buy decisions for claims infrastructure (e.g., pricing data, vendor tooling, etc.) and make informed choices with clear tradeoff reasoning.

• Guide a cross-functional team of engineers, designers, and data scientists to deliver high-impact improvements.

• Manage complex, cross-functional initiatives—such as system migrations, platform upgrades, and new payer/vendor integrations—from discovery to launch.

• Navigate compliance-driven requirements (e.g., No Surprises Act and other regulatory constraints) and translate them into clear, actionable product requirements.

• Collaborate closely with engineering, claims operations SMEs, and compliance stakeholders to scope initiatives, define MVPs, and sequence a heavily interdependent roadmap.

• Produce clear, detailed PRDs and specifications that withstand scrutiny from engineering, compliance, and executive stakeholders.

• Utilize data and experimentation to assess the performance of automated workflows and continuously enhance accuracy and throughput.

• Establish and refine product practices tailored for a platform that encompasses both infrastructure and intelligent systems.

• Stay updated on the rapidly changing AI landscape and convert emerging capabilities into tangible product opportunities.

• Develop strong product practices designed to meet the unique challenges associated with delivering AI products.

• Set ambitious goals and maintain accountability for achieving them.

⛳️ Requirements

• Bachelor’s or Master’s degree in Computer Science, Information Systems, Business Administration, or a related discipline.

• Over 5 years of product management experience focusing on processing systems with workflows, queues, routing, and automation.

• Proven track record of taking AI products from concept to launch, addressing the unique challenges posed by non-deterministic systems—evaluation, safety, prompt design, and user trust.

• Profound understanding of AI agents and agentic architectures; you have delivered systems where AI executes sequences of actions rather than merely generating responses.

• Experience defining AI product quality metrics that extend beyond traditional A/B testing methodologies.

• Strong instincts for designing auditable and traceable systems, as this role operates within financial-transaction and regulatory workflows where “mostly right” is inadequate without a clear audit trail.

• Solid design and UX sensibilities, particularly for data-intensive applications and interactions.

• Proven ability to craft clear, rigorous specifications for both deterministic systems (data pipelines, integrations, migrations) and non-deterministic ones (classification, extraction, routing logic), detailing how you evaluate and build confidence in each.

• Experience collaborating with engineering on build vs. buy vs. integrate decisions, including vendor assessments.

• Proficiency in SQL for independent data analysis.

• Comprehensive understanding of Agile methodologies.

• Capability to manage numerous interdependent workstreams and effectively communicate sequencing tradeoffs to engineering, operations, and executive stakeholders.

• Experience working cross-functionally across engineering, operations, compliance, and business stakeholders.

• Background in claims processing, health insurance, or other regulated financial-transaction domains is advantageous, but not essential—we value strong platform PMs from other complex domains equally.

• Experience as a startup 0-to-1 builder is highly desirable—we seek individuals who have launched products under constraints and learned from real user interactions.

🏝️ Benefits

• Competitive salary, bonus opportunities, and an equity package.

• Comprehensive medical, dental, and vision benefits.

• A 401k retirement plan.

• Paid vacation and company holidays.

• Opportunity to make a significant impact at a rapidly growing, mission-driven company transforming healthcare in the U.S.