Product Manager, Fraud & Abuse

CVS Health•New York, MA

1d•$92,700 - $203,940•Onsite

About The Position

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.

Requirements

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

Nice To Haves

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

Responsibilities

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