Product Manager, Fraud & Abuse

Product Manager For Fraud & Abuse

We're building a world of health around every individual shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger helping to simplify health care one person, one family and one community at a time.

As a Product Manager for Fraud & Abuse, you will lead the ongoing development and expansion of key Fraud, Waste, and Abuse (FWA) products that deliver over $200M in annual impact. In this role, you will directly support CVS Health's Payment Optimization Analytics objectives, contributing to the achievement of revenue and ROI targets for analytics products. You will be responsible for monitoring product performance, driving enhancements, and overseeing the deployment and scaling of advanced FWA analytics capabilities.

Key Duties Will Be:

• Own the product vision, strategy, and performance, ensuring delivery of measurable business value and alignment with organizational goals
• Identify and prioritize opportunities to integrate AI/ML capabilities into products to enhance accuracy, efficiency, and scalability
• Translate market trends, user feedback, and competitive intelligence into actionable product direction, monitoring shifts to identify emerging opportunities and risks
• Lead a cross-functional squad of data engineers, data scientists, and ideation team members, managing competing priorities and perspectives to keep the squad focused and moving forward
• Define and document the "what" and "why" for the squad, including setting the problem, shaping priorities, and making tradeoffs clear
• Develop and maintain core product artifacts including roadmap, backlog, sprint plans, and demo materials
• Facilitate key forums including stakeholder sessions, sprint planning, working sessions, and product demos
• Continuously evaluate advancements in AI/ML and assess applicability to enhance the product portfolio
• Establish and monitor KPIs related to product performance, adoption, and business impact
• Develop compelling, data-driven business cases for new product capabilities and enhancements, securing stakeholder alignment and financial investments to support strategic priorities
• Ensure high-quality, timely delivery of product enhancements that meet defined business and technical requirements

Required Qualifications

• 3+ years of experience in product management or product ownership
• 3+ years of experience within the healthcare industry
• Demonstrated experience managing product roadmaps and defining product requirements
• Proven ability to influence and collaborate effectively across cross-functional teams and senior stakeholders
• Ability to operate in ambiguity, translating evolving business objectives into clear, prioritized initiatives
• Experience leveraging AI/ML technologies to drive measurable business value
• Ability to analyze complex data and translate insights into actionable product strategy and business decisions

Preferred Qualifications

• Experience in Payment Integrity, with a focus on Fraud, Waste, & Abuse (FWA)
• Strong financial acumen, with the ability to assess business impact and drive value-based decisions
• Experience working within Agile product management frameworks and methodologies
• Working knowledge of healthcare claims processing, including end-to-end claims lifecycle

Education

• Bachelor's degree or equivalent work experience with healthcare, claims processing, or vendor management

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$92,700.00 - $203,940.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.