Note: The job is a remote job and is open to candidates in USA. Harnham is recruiting for a global analytics and AI consultancy seeking a Senior Product Owner / Product Manager to modernise clinical claims data products for healthcare payer organisations. The role leads stakeholder discovery, translates business and clinical needs into product requirements, and supports governance, validation, adoption, and production transition.

Responsibilities

• Lead discovery workshops with business, clinical, actuarial, claims operations, compliance, analytics, and technology stakeholders to understand current claims classification and grouper workflows
• Translate business and clinical requirements into BRDs, user stories, process maps, business rules, acceptance criteria, and validation documentation
• Define requirements for clinical claims data products covering inpatient, outpatient, professional, ancillary, and pharmacy claims
• Support baseline-to-target comparisons, variance analysis, business impact assessments, UAT planning, and migration readiness activities
• Partner with data engineering, analytics, and AI/ML teams to define data mappings, quality standards, validation rules, and product requirements
• Drive stakeholder alignment, governance processes, adoption readiness, and production transition planning for modernised claims data products

Skills

• Strong experience within healthcare payer claims, claims analytics, medical economics, actuarial analytics, payment integrity, clinical coding, or healthcare data product delivery
• Deep understanding of medical groupers, claims classification methodologies, service category logic, claims editing, or payer claims rule frameworks
• Knowledge of healthcare claims and coding concepts including ICD-10, CPT, HCPCS, DRG, APC, modifiers, revenue codes, place of service, and 837/835 transactions
• Ability to assess how claims classification impacts cost and utilisation reporting, provider analytics, value-based care, risk adjustment, actuarial reporting, and total cost of care analysis
• Experience creating business requirements, process maps, decision tables, source-to-target mappings, testing documentation, and validation frameworks
• Strong stakeholder management and workshop facilitation skills across clinical, actuarial, operational, compliance, analytics, and technology teams
• Familiarity with platforms or methodologies such as Milliman, MedInsight, Solventum/3M, Optum, Cotiviti, CMS grouping logic, DRG/APC workflows, or similar healthcare claims solutions
• Experience working alongside engineering, data, and AI/ML teams to deliver healthcare data products and analytics solutions

Benefits

• Remote work, but must be US based

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