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Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.
The Director of Product for Payment Integrity Solutions plays a pivotal role in leading the strategic development and management of a complex suite of solutions within Carelon's Payment Integrity Product division. This includes overseeing products such as Complex Clinical Audit (CCA), Provider Education (PE), and Special Investigations Unit (SIU), each targeting cost of care savings by identifying anomalies, fraud, waste, and errors. The Director will lead a team of diverse product managers and owners to build and execute a robust product roadmap aligned with cost-reduction targets. This role demands strategic thinking beyond simply meeting client needs; it requires envisioning and proposing innovative products that could enhance operational efficiencies and savings across commercial and government health plans. Additionally, the Director will foster relationships with various functional business leads within Payment Integrity, ensuring their collaboration drives the annual roadmap to success while preparing for future advancements. This position will work in a hybrid way from any US Elevance Health corporate location.
How you will make an impact:
Oversees strategy and implementation of new and existing products, ensuring alignment with cost-saving targets and strategic objectives.
Leads market research initiatives to effectively incorporate national trends, corporate strategy, and insights into competitive strengths to inform product development.
Collaborates closely with functional Payment Integrity Business Leads and matrix partners, including the PI Strategy Team, PI Operations team, and marketing teams, to craft a robust product roadmap that meets annual goals and anticipates future needs.
Hires, trains, coaches, and evaluates performance of direct reports, promoting a culture of strategic thinking and continuous improvement.
Supports business development efforts through strategic alignment with client business leaders to secure funding and buy-in for new product initiatives to meet organizational goals and cost of care savings objectives.
Works closely with clients and cross-functional teams to ensure product solutions meet claims data requirements from diverse system sources and deliver optimal outcomes.
Requires a BA/BS degree and a minimum of 7 years of related experience; or any combination of education and experience, which would provide an equivalent background.
Highly preferred skills and experiences:
Experience leading a team of product managers and owners.
Experience managing a product portfolio comprised of multiple complex healthcare solutions.
Experience in healthcare payment integrity business serving providers or payers such as a payment integrity vendor, payment integrity inside a health plan, or a revenue cycle firm.
Strong understanding in Scaled Agile Framework (SAFe) and Product Lifecycle Management (PLM).
Proven product experience in a matrixed and complex healthcare business environment.
Proven success with cross-functional collaborative relationship building to align business priorities.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.