{"schemaVersion":"jobsearcher.job.v1","id":"2aecf2465179cc856c19640d","url":"https://jobsearcher.com/jobs/2aecf2465179cc856c19640d","canonicalUrl":"https://jobsearcher.com/jobs/2aecf2465179cc856c19640d","title":"Technical Program Manager","description":"Job Title: TPM (Technical Program Manager)Location: USA RemoteJob Type: Permanent/FTEPrimary ResponsibilitiesGolden Dataset & Claim Scenario CreationGenerate test claims as a Payer and Adjudication Subject Matter Expert to support agentic AI solution evaluations, both for internal support functions and governance (Agent Evaluation Systems, AIRB, etc.)Generate files to simulate and support Payer Operations AI solutions (benefit, pricing, etc), both for internal support and governanceIdentify or construct representative claim scenarios aligned to business and product requirements, then de-identify and modify data as neededTranslate product requirements into scalable testing files covering both core functionality and edge casesAdjudication & Outcome DeterminationManually apply benefit and adjudication rules to create expected outcomes aligned with the scope and data sources of each agentic solutionValidation of simulated payer filesDetermine allow/reject determinations with clearly supporting rationale, and calculate financial impacts and member responsibilityEnsure citation and traceability of determination logic so outcomes can be defended in reviewStructured Output Generation & QACreate structured outputs — X12, JSON, Excel, and answer keys — to support agent testing and evaluationPerform quality assurance on generated files and outcomes to ensure accuracy and consistencyModel Testing, Evaluation & Governance SupportProvide direct support for model testing, agent evaluation cycles, and AIRB reviewsPartner with Product, Engineering, and AI Governance stakeholders to ensure datasets meet evaluation and release requirementsContribute to standardizing adjudication logic and reasoning so outputs are consistent and repeatable across scenariosRequired Qualifications5+ years of experience in product management, claims operations, or payer testing/QA rolesStrong payer domain knowledge, including claims, benefits, prior authorization, and policy/editing logicDirect experience with operational pain points such as denials, call center burden, and configuration complexityHands-on experience with AI/ML-driven products, including defining use cases and working with data/engineering teamsAbility to manually apply adjudication and benefit rules to determine accurate claim outcomesComfort working with structured data formats (X12, JSON) and QA processesPreferred QualificationsExperience supporting model testing, agent evaluation, or AI governance/review board processesFamiliarity with agentic AI systems or LLM-based automation in a healthcare/payer contextExperience building or QA-ing test data, answer keys, or validation scenarios at scaleWorking knowledge of Excel-based output generation and data QA toolingX12 Claims ExperiencePayer Operation file experience","company":"Mpower Plus","rawCompany":"mpower plus","city":"Denver","state":"CO","isRemote":false,"isActive":false,"createdAt":"2026-09-25T09:36:38.336Z","occupations":[{"code":"15-1299.09","title":"Information Technology Project Managers","slug":"information-technology-project-managers"},{"code":"13-1082.00","title":"Project Management Specialists","slug":"project-management-specialists"},{"code":"15-1253.00","title":"Software Quality Assurance Analysts and Testers","slug":"software-quality-assurance-analysts-and-testers"}],"industries":[{"code":"524292","title":"Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds","slug":"pharmacy-benefit-management-and-other-third-party-administration-of-insurance-and-pension-funds"},{"code":"541511","title":"Custom Computer Programming Services","slug":"custom-computer-programming-services"},{"code":"524298","title":"All Other Insurance Related 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create expected outcomes aligned with the scope and data sources of each agentic solutionValidation of simulated payer filesDetermine allow/reject determinations with clearly supporting rationale, and calculate financial impacts and member responsibilityEnsure citation and traceability of determination logic so outcomes can be defended in reviewStructured Output Generation & QACreate structured outputs — X12, JSON, Excel, and answer keys — to support agent testing and evaluationPerform quality assurance on generated files and outcomes to ensure accuracy and consistencyModel Testing, Evaluation & Governance SupportProvide direct support for model testing, agent evaluation cycles, and AIRB reviewsPartner with Product, Engineering, and AI Governance stakeholders to ensure datasets meet evaluation and release requirementsContribute to standardizing adjudication logic and reasoning so outputs are consistent and repeatable across scenariosRequired Qualifications5+ years of experience in product management, claims operations, or payer testing/QA rolesStrong payer domain knowledge, including claims, benefits, prior authorization, and policy/editing logicDirect experience with operational pain points such as denials, call center burden, and configuration complexityHands-on experience with AI/ML-driven products, including defining use cases and working with data/engineering teamsAbility to manually apply adjudication and benefit rules to determine accurate claim outcomesComfort working with structured data formats (X12, JSON) and QA processesPreferred QualificationsExperience supporting model testing, agent evaluation, or AI governance/review board processesFamiliarity with agentic AI systems or LLM-based automation in a healthcare/payer contextExperience building or QA-ing test data, answer keys, or validation scenarios at scaleWorking knowledge of Excel-based output generation and data QA toolingX12 Claims ExperiencePayer Operation file experience","datePosted":"2026-09-25T09:36:38.336Z","dateModified":"2026-09-25T09:36:38.336Z","hiringOrganization":{"@type":"Organization","name":"Mpower Plus","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Denver","addressRegion":"CO","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"2aecf2465179cc856c19640d"},"url":"https://jobsearcher.com/jobs/2aecf2465179cc856c19640d"}}