New

Product Owner, Claims Editing (RTM)

Vaco
$12000 - $135000 / Year
United States, Florida, Tampa
Oct 16, 2026
100% remote in US $120,000-135,000 + 10% yearly bonus REQUIRED: 4 or more years of experience in healthcare claims editing, payment integrity, medical coding, reimbursement, medical policy, or claims analytics. About the Role The Product Owner, Claims Editing identifies, designs, and supports the implementation of automated claim edits that drive incremental value, improve payment accuracy, and generate revenue across claims-editing programs. The role initially focuses on Routine Test Management (RTM), with potential support for Routine Radiology Management (RRM) and Genetic Testing Management (GTM). This position partners with Scientific Affairs and Coding & Translation to review existing and emerging policies, identify opportunities for additional claims enforcement, and translate approved requirements into clear, configuration-ready rules. The role also analyzes claims data using approved AI tools to estimate financial impact, collaborates with Configuration and APEA Development on testing and implementation, and supports Product and Account Management with training, claim examples, and client adoption. Responsibilities Maintain a prioritized pipeline of opportunities to enhance existing policies and develop new automated claim edits. Review medical policies, coding guidance, regulatory updates, and new publications in collaboration with Scientific Affairs and Coding & Translation to identify opportunities for additional enforcement. Translate approved policy requirements into clear, testable business rules and configuration specifications, including codes, triggers, exclusions, and expected outcomes. Evaluate existing claim-editing capabilities and recommend new functionality when needed. Analyze claims data using approved AI/LLM tools and other analytical methods to estimate eligible claim volume, potential savings, incremental revenue, and client impact. Develop claim examples and test scenarios, coordinate handoffs to Configuration, and validate claim-editing decisions and outcomes. Create training materials, process walkthroughs, FAQs, and decisioning examples for Product, Account Management, and clients. Monitor implemented edits and recommend enhancements to improve accuracy, financial performance, and client adoption. Serve as a key liaison among Product, Scientific Affairs, Coding & Translation, Configuration, APEA Development, Account Management, and Analytics to ensure alignment throughout the edit development lifecycle. Minimum Qualifications 4+ years of experience in healthcare claims editing, payment integrity, medical coding, reimbursement, medical policy, or claims analytics. Bachelor's degree in a related field, or 8+ years of directly applicable experience. Working knowledge of healthcare claims, claims adjudication, medical coding systems, and automated claim-editing concepts. Demonstrated ability to translate medical, coding, or reimbursement policies into clear, testable business rules. Experience analyzing claims data and estimating operational and financial impact using Excel, SQL, business intelligence tools, or similar analytical solutions. Familiarity with generative AI and large language models (LLMs), including the ability to validate AI-assisted outputs against authoritative sources. Strong analytical, documentation, presentation, and cross-functional communication skills. Preferred Qualifications Direct experience developing, testing, or implementing automated claim edits or payment-integrity rules. Experience with laboratory, genetic testing, radiology, or other medical-benefit claims. Experience working at a health plan, claims-editing vendor, payment-integrity organization, or healthcare technology company. Familiarity with APEA or another claims-editing platform. Experience with SQL, data visualization, Agile methodologies, or client training. By submitting to this position, you are agreeing to be included in our talent pool for future hiring for similarly qualified positions. EEO Notice Vaco by Highspring is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race (including but not limited to traits historically associated with race such as hair texture and hair style), color, sex (includes pregnancy or related conditions), religion or creed, national origin, citizenship, age, disability, status as a veteran, union membership, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, political affiliation, or any other protected characteristics as required by federal, state or local law. Vaco by Highspring and its parents, affiliates, and subsidiaries are committed to the full inclusion of all qualified individuals. As part of this commitment, Vaco by Highspring and its parents, affiliates, and subsidiaries will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact HR@vaco.com. Vaco by Highspring also wants all applicants to know their rights that workplace discrimination is illegal. Representation Notice By submitting to this position, you agree that you will be giving Vaco by Highspring the exclusive right to present your as a candidate for the foregoing employment opportunity. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. You also agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco by Highspring about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco by Highspring agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal. For residents of Ontario, Canada: Based on Highspring's discussions with its Client, Highspring's understanding is that this position for employment is a current vacancy (either through Highspring as a contractor or with the client directly). Privacy Notice Vaco by Highspring and its parents, affiliates, and subsidiaries ("we," "our," or "Vaco by Highspring") respects your privacy and are committed to providing transparent notice of our policies. California residents may access Vaco by Highspring HR Notice at Collection for California Applicants and Employees here. Virginia residents may access our state specific policies here. Residents of all other states may access our policies here. Canadian residents may access our policies in English here and in French here. Residents of countries governed by GDPR may access our policies here. Additionally, submissions to this position are subject to the use of AI to perform preliminary candidate screenings, focused on ensuring minimum job requirements noted in the position are satisfied. More details about Vaco by Highspring's use of AI can be found here (https://www.highspring.com/ai-use-notices/). Further assessment of candidates beyond this initial phase will be conducted by recruiters and hiring managers. Vaco by Highspring does not know and cannot opine on if its client's use of AI products in hiring. Pay Transparency Notice Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to: the individual's skill sets, experience and training; licensure and certification requirements; office location and other geographic considerations; other business and organizational needs. With that said, as required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses.