UM Product Operations Analyst (Remote)

Responsibilities

• Data Management & Testing
• Transferring payer and clinical data into internal software systems.
• Creating and executing test strategies, plans, and cases for software and AI/NLP features including creating, maintaining and overseeing customer implementation plans for tree creation.
• Documenting defects using a bug tracking system, test for data accuracy, and participate in quality audits to maintain high standards of technical rigor.
• Reviewing accounts, documenting activity, and ensuring compliance with production goals.
• AI/NLP Model Support
• Collaborating with product and engineering teams to test and validate NLP models using clinical concepts.
• Developing and executi

Benefits

Additional Information

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change. At Availity, we're not just another Healthcare Technology company; we're pioneers reshaping the future of healthcare! With our headquarters in vibrant Jacksonville, FL, and an exciting office in Bangalore, India, along with an exceptional remote workforce across the United States, we're a global team united by a powerful mission. We're on a mission to bring the focus back to what truly matters - patient care. As the leading healthcare engagement platform, we're the heartbeat of an industry that impacts millions. With over 2 million providers connected to health plans, and processing over 12 billion transactions annually, our influence is continually expanding. Join our energetic, dynamic, and forward-thinking team where your ideas are celebrated, innovation is encouraged, and every contribution counts. We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem. In this role, you will support and help advance an AI-enabled utilization management (UM) solution that automates and modernizes the prior authorization process for healthcare organizations. The solution is designed to ensure clinical accuracy, regulatory compliance, and operational efficiency by translating complex clinical and payer requirements into structured, scalable logic. The UM Product Operations Analyst manages payer and clinical data, supports software testing, and drives process improvements. You will play a key role in collaborating across departments to ensure operational excellence. A unique aspect of this position is supporting the testing and evaluation of AI capabilities, specifically Natural Language Processing (NLP) models that leverage clinical concepts. You will help validate model outputs, contribute to annotation and test case development, and provide feedback to improve AI-driven solutions in the healthcare domain. Sponsorship, in any form, is not available for this position. Location: Remote, US Why you want to work on this team: - Passionate about doing meaningful impact work in healthcare by helping modernize prior authorization and reducing administrative burden so providers can focus more on patient care. - Be part of cutting-edge innovation at the intersection of healthcare, AI, and operations, supporting solutions that use NLP and automation to solve complex industry challenges. - Enjoys taking ownership and drive improvement in a role that values initiative, critical thinking, and process optimization. To be qualified for this position you have: - Undergraduate degree is preferable, but applicable experience in a health care setting will be strongly considered in lieu of a degree.. - Prior relevant experience in healthcare or utilization management strongly preferred. - Experience with AI/NLP model testing or annotation is a plus. - Advanced proficiency in Excel and general computer skills (Microsoft Office suite). - Ability to create and execute test strategies, plans, and cases. - Experience with bug tracking systems and EMRs is a plus. - Familiarity with CPT and ICD-10-CM coding, Medicare/Medicaid, and NCD/LCD is beneficial. - Strong knowledge of healthcare and medical terminology. - Excellent problem-solving, critical thinking, and attention to detail. - Ability to work independently and as part of a team. - Organized, able to multitask, responsible, and proactive. - Open to giving and receiving feedback. - Strong written and verbal communication skills, including the ability to communicate complex technical issues to internal and external stakeholders. - Comfortable with ambiguity and able to design organized approaches to address challenges. - Ability to take on meaningful responsibility and thrive with limited supervision. You will set yourself apart with: - Deep experience in understanding prior auth workflows. - Client-facing or stakeholder communication experience. - Advanced Excel Skills

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at availity? Share your experience