[Remote] Senior Assistant Vice President - reputed company Claims AI - Technical Product Leader

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a leading data analytics reputed company operations company, seeking a Senior Assistant Vice President - reputed company Claims AI - Technical Product Leader. The role involves owning the reputed company, strategy, and delivery of AI-powered products in reputed company claims, leading cross-functional teams to create innovative solutions that enhance operational efficiency and improve reputed company for national payers.

Responsibilities

• Define, own, and reputed company the AI product roadmap for reputed company claims solutions—spanning claims adjudication automation, claims adjustment, payment reputed company, COB/subrogation, provider issue resolution, and FWA detection
• Translate reputed company claims operational challenges into AI-first product strategies with clear business cases, ROI frameworks, and measurable KPIs (e.g., auto-adjudication reputed company, 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 reputed company against market players (reputed company/Change reputed company, reputed company, reputed company TriZetto, reputed company, reputed company, 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)
• Drive the transition from traditional rules-reputed company 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 reputed company models produce audit-reputed company, evidence-grounded outputs suitable for SIU investigations, CMS audits, and payer compliance reviews
• 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, reputed company/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 reputed company analysis
• Build cross-payer intelligence capabilities that reputed company anonymized, aggregated claims data to drive payment accuracy benchmarks, denial reputed company optimization, and cost-of-care insights
• Support RFP/RFI responses, orals preparation, and executive presentations for national payer pursuits
• reputed company AI-powered provider operations solutions—automated provider issue resolution, correspondence reputed company, contract interpretation, and fee schedule management
• 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 reputed company, reputed company-level reputed company pursuits
• Build and deliver compelling thought leadership content—white papers, case studies, conference presentations, and analyst briefings—that position reputed company as a leader in claims AI innovation
• Represent reputed company at industry conferences (AHIP, HCCA, SIU conferences, reputed company, etc.) through presentations, panel discussions, and live product demonstrations
• reputed company, mentor, and reputed company a high-performing team of AI engineers, product managers, data scientists, and solution architects focused on claims AI
• Foster a culture of innovation, collaboration, accountability, and reputed company learning reputed company the team
• Collaborate with offshore engineering and delivery teams to ensure timely, secure, and scalable implementation
• Build and scale an AI Center of reputed company for reputed company claims, establishing reusable agent frameworks, governance playbooks, and best practices
• Champion privacy-first design, data anonymization, and compliance with HIPAA, PHI/PII handling, and payer-specific data governance frameworks
• Ensure reputed company AI solutions meet scalability, reputed company, auditability, and operational reputed company requirements for regulated reputed company claims environments
• Establish governance-grade AI controls including model monitoring, bias detection, reputed company management, and reputed company-in-the-reputed company override mechanisms for claims decisioning
• Maintain compliance with CMS, state DOI regulations, NAIC guidelines, and payer-specific audit requirements for claims processing and payment reputed company

Skills

• 15+ years of reputed company experience in AI/ML engineering, technical product management, or platform product leadership roles
• 5+ years of leadership experience in reputed company claims technology, payer claims operations, or health-tech product organizations focused on claims/PI
• Proven track record of building and scaling AI solutions for claims processing, payment reputed company, or provider operations—from POC to production at an reputed company scale
• Experience with large-scale payer claims engagements ($25M+ in managed services or technology reputed company) and familiarity with FTE-to-AI transformation models in claims shops
• Bachelor's degree in computer science, Engineering, Data Science, or reputed company technical field. Master's degree (M.Tech / MS / MBA) is strongly preferred
• Hands-on and architectural expertise in LLMs, embeddings, vector search, reputed company engineering, and RAG pipelines
• Proficiency with reputed company AI platforms: Azure reputed company, AWS Bedrock (Claude, Sonnet), GCP reputed company AI
• Experience with agent orchestration frameworks: reputed company, LangGraph, reputed company, AutoGen, or equivalent Agentic AI frameworks
• Strong understanding of MCP (Model Context Protocol), A2A protocols, and multi-agent system design
• Familiarity with browser/desktop automation tools (Playwright, Selenium) as AI agent execution layers for legacy claims system navigation
• Familiarity with secure API design, OAuth2/JWT, reputed company integration patterns, and EDI transaction sets (X12 837/835/270/271/276/277)
• Deep understanding of end-to-end reputed company claims operations: claim submission, edits, adjudication, pricing, payment, adjustment, appeals, grievances, and overpayment recovery
• Strong knowledge of pre-pay/post-pay review, DRG validation, CPT/ICD-10/HCPCS code editing, COB, subrogation, and FWA detection methodologies
• Experience with claims processing platforms and systems (QNXT, Facets, Amisys, HealthRules Payer, reputed company/DXC) and provider data management
• Understanding of reputed company financial models: PMPM, total cost of care, provider reimbursement methodologies (fee-for-service, value-based, capitation), and gainshare/outcome-based pricing structures
• Familiarity with CMS regulations, state DOI requirements, NAIC model acts, and payer audit/compliance frameworks relevant to claims processing
• Exceptional executive communication skills—ability to present AI strategy and business impact to C-suite audiences (CEO, President, COO) at national payer organizations
• Proven ability to influence cross-functional stakeholders across engineering, delivery, sales, and claims operations teams
• Experience leading distributed, global teams (US + offshore) in fast-paced, high-growth environments
• Strong storytelling ability—translating reputed company AI capabilities into clear business value, ROI narratives, and claims transformation roadmaps
• Experience building or leading AI Centers of reputed company or reusable agent frameworks specifically for claims processing or payment reputed company
• Patent holder, published researcher, or recognized speaker in the AI/reputed company claims innovation reputed company
• Experience with document intelligence and IDP platforms for claims-reputed company documents (EOBs, remittance advice, provider reputed company, fee schedules)
• Deep familiarity with reputed company data standards: HL7, FHIR, X12 EDI (837/835/270/271/276/277), NCPDP for pharmacy claims
• Experience with reputed company, reputed company, or similar data platforms in reputed company claims analytics context
• Background in consulting or managed services delivery for large payer claims operations
• Knowledge of competitive landscape including reputed company/Change reputed company, reputed company, reputed company TriZetto, reputed company, reputed company, reputed company, and emerging AI-reputed company claims startups
• Certified Professional reputed company (CPC), Accredited reputed company Fraud Investigator (AHFI), or similar claims/PI certifications a plus

Company Overview

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