Senior Product Owner, Clinical Claims & Grouper Solutions

Fractal is a strategic AI partner to Fortune 500 companies with a vision to power every human decision in the enterprise. Fractal is building a world where individual choices, freedom, and diversity are the greatest assets. An ecosystem where human imagination is at the heart of every decision. Where no possibility is written off, only challenged to get better.

We believe that a true Fractalite is the one who empowers imagination with intelligence. Fractal has been featured as a Great Place to Work by The Economic Times in partnership with the Great Place to Work® Institute and recognized as a ‘Cool Vendor’ and a ‘Vendor to Watch’ by Gartner.

Please visit Fractal Intelligence for Imagination for more information about Fractal

Role Overview

Fractal is seeking a Senior Product Owner for Clinical Claims & Grouper Solutions. This is for a clinical claims data product to support healthcare payer clients in modernizing clinical claims data products, medical grouper capabilities, and claims classification workflows.

This is a client-facing functional role for someone with strong experience in payer claims, healthcare coding, medical groupers, claims analytics, medical economics, payment integrity, actuarial analytics, or healthcare data product delivery. The role will partner with business, clinical, actuarial, claims, analytics, data engineering, and AI/ML teams to define requirements, validate outputs, assess downstream impacts, and support adoption readiness for modernized clinical claims data products.

The candidate must understand how claims data and clinical coding translate into grouped outputs that drive payer workflows and analytics. This includes how claims classification supports cost and utilization analysis, medical economics, actuarial reporting, operational workflows, clinical programs, and broader business decision-making.

This person is not expected to be a hands-on data scientist or engineer but must be able to partner effectively with technical teams and bring strong payer claims / medical grouper domain judgment.

What You’ll Do

Discovery, Current-State Assessment, and Workflow Mapping

• Lead discovery workshops with payer business, clinical, coding, actuarial, claims operations, compliance, analytics, data science, and technology stakeholders.
• Document current-state claims classification and grouper usage, including business workflows, data inputs, outputs, pain points, downstream dependencies, and analytics use cases.
• Map how claims classification outputs are used across medical economics, actuarial reporting, cost-of-care analysis, utilization benchmarking, provider analytics, payment integrity, claims operations, care management, clinical policy, finance, quality, value-based care, and executive reporting.
• Identify major reports, dashboards, models, workflows, and business decisions that depend on grouper, service category, or claims classification outputs.

Requirements Specification and Clinical Claims Data Product Architecture

• Translate payer claims, coding, clinical policy, operational, actuarial, medical economics, and analytics needs into BRDs, user stories, process maps, decision logic, business rules, acceptance criteria, and validation documentation.
• Define requirements for clinical claims data products across claim types such as inpatient, outpatient, professional, ancillary, and pharmacy/Rx.
• Support design and validation of service category frameworks used for cost, utilization, benchmarking, reporting, and downstream analytics.
• Partner with technical teams to define data inputs, outputs, source-to-target mappings, validation rules, interfaces, and data quality expectations.
• Ensure claims classification and service category outputs are traceable, testable, explainable, auditable, versioned, and aligned to business outcomes.

Baseline Comparison, Validation, and Migration Readiness

• Support baseline-to-target output comparison, parallel validation, variance analysis, business impact assessment, and migration readiness planning.
• Help define what “ready for adoption” means for each business use case, including accuracy, explainability, financial impact, operational impact, reporting continuity, trend stability, and stakeholder sign-off.
• Evaluate impact on downstream analytics such as cost-of-care reporting, utilization benchmarks, actuarial trend, PMPM reporting, provider analytics, value-based care performance, clinical program analyti…