At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start
Caring. Connecting. Growing together.UMR is seeking Product Capability Manager - AI Transformation to support the design and implementation of Agentic AI solutions transforming healthcare claims operations. These roles will work closely with product leaders, technology teams, and domain experts to translate complex claims processing rules into clear business requirements, AI prompts, decision logic, and operational workflows. The Product Capability Manager will play a critical role in enabling AI-driven capabilities that improve claim adjudication efficiency, payment integrity outcomes, and operational accuracy across multiple AI products.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities:- Partner with stakeholders to identify and prioritize AI use cases based on business value
- Drive capability vision, strategy, priority and roadmap and engage appropriate enterprise-wide stakeholders to enable awareness and alignment. Own capability backlog and feature/use case prioritization decisions
- Define success metrics and measure product and capability performance and own outcomes
- Lead product lifecycle management from ideation through deployment and enhancement
- Manage the capability and its usage across businesses across the lifecycle, using a defined development process. Drive adoption and value realization of AI-enabled capabilities
- Lead detailed requirements gathering and analysis for AI-enabled claims operations initiatives
- Translate healthcare claims policies, SOPs, and operational guidelines into structured requirements, decision rules, and AI prompts
- Collaborate with Product, IT, Data Science, UX, Clinical, Pricing, and Payment Integrity stakeholders to design AI-assisted claims workflows
- Convert complex claims logic (eligibility/benefits, coding edits, modifiers, COB, authorization rules, contract pricing, bundling/unbundling, and recoupment logic) into testable system requirements
- Develop detailed user stories, functional specifications, acceptance criteria, and traceability documentation
- Support development and refinement of AI agent prompts, decision logic, and rule configurations used in claims automation workflows
- Participate in solution design sessions to ensure business logic is accurately represented in system functionality
- Support testing, validation, and operational readiness of AI-enabled claims capabilities
- Document business processes, operational workflows, and system interactions for new AI-driven capabilities
- Collaborate with program leadership to ensure alignment across multiple Agentic AI products and maintain consistency in requirements standards
- Serve as the capability champion and apply deep expertise to credibly represent, manage and engage with business(es)
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- 5+ years of experience in healthcare payer operations, healthcare consulting, or healthcare technology delivery
- 3+ years of experience working with healthcare claims processing including eligibility/benefits, claims edits, coding logic, COB, or pricing
- Experience writing business requirements, user stories, functional specifications, and acceptance criteria
- Experience collaborating with cross-functional teams including IT, product management, and operations stakeholders
- Experience defining or contributing to AI use case strategy, including problem framing, value hypotheses, and measurable success metrics
- Experience in creating structured strategies and solution artifacts (e.g., use case briefs, process flows) and integrating models into existing products/capabilities
- Experience in PDLC and AIDLC while leveraging modern product management tools - Aha!, JIRA, FIGMA, MIRO, GitHub, etc.
- Proven solid analytical skills with the ability to translate complex operational processes into structured requirements
- Proven solid written and verbal communication skills
- Proven ability to design or operate within AI intake and prioritization frameworks, including evaluating initiatives based on business impact, feasibility, and adoption potential
Preferred Qualifications:- Experience supporting AI, automation, or advanced analytics initiatives within healthcare payer operations
- Experience translating policy or clinical guidelines into operational or system rules
- Experience working with large payer organizations or TPAs
- Experience evaluating and supporting legal, compliance, and risk considerations for AI solutions, including areas such as model governance, responsible AI, and regulatory alignment
- Exposure to prompt engineering, rule engines, or decision automation platforms
- Knowledge of claims adjudication systems, payment integrity platforms, or healthcare pricing tools
- Working knowledge of production AI systems, including MLOps or deployment considerations
- Familiarity with Agile development methodologies and product delivery frameworks
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Never miss an opportunity! Create an alert based on the job you applied for.