Description

You will serve as a strategic leader and primary subject matter expert for our AI-enabled claim auditing product line, working directly with payer clients to shape how solutions are designed, deployed, and refined. This role sits at the intersection of clinical expertise, payment integrity operations, and technology-driven innovation.

Requirements

• 10+ years of hands-on experience at a payer or payer vendor in a product or operational role with focus on complex claims auditing.
• Deep, hands-on knowledge of end-to-end complex claims auditing workflows.
• Clinical training or active coding certification.
• Expertise in one or more complex claim types: Inpatient (DRG validation), Outpatient (modifiers), Post-Acute Care, Medical Necessity, Specialty/High Cost Drugs.
• Knowledge of payer-side data systems (claims adjudication platforms, audit automation engines, care management systems).
• Familiarity with audit-relevant regulatory frameworks: CMS guidelines, Medicare/Medicaid audit requirements, RAC/MAC/OIG standards.
• Ability to translate complex clinical and operational requirements into clear product and technical specifications for non-clinical stakeholders.
• Demonstrated ability to engage, consult, and build trust with payer clients at the operational and leadership levels.

Responsibilities

• Serve as the internal and external SME for end-to-end claims auditing workflows, spanning both pre-pay and post-pay audit processes.
• Partner with Product, Engineering, and AI teams to translate auditing workflows into intelligent, AI-powered solution requirements.
• Act as client-facing expert, partnering closely with Sales and Delivery on client/prospect meetings, product demos, discovery sessions, and client support.
• Identify gaps between current product capabilities and real-world auditing needs; champion a roadmap that closes those gaps.
• Represent the voice of the complex case review audit team in cross-functional product discussions, ensuring clinical accuracy and operational practicality.
• Partner with product and growth marketing on sales enablement, growth marketing initiatives, thought leadership, and GTM execution.