Product Manager, Fraud & Abuse

About the role

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.

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

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
• Able 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

Qualifications

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

Pay

The Typical Pay Range For This Role Is $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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.