Program Integrity Product Manager

Program Integrity Product Manager

100% Remote

Contract-to-Hire

Primary Responsibilities

• Define, own, and champion the product vision, multi-year strategy, and roadmap for Program Integrity solutions focused on fraud, waste, and abuse detection and prevention.
• Translate Medicaid Program Integrity challenges, client needs, market trends, regulatory changes, and competitive intelligence into clear product priorities and differentiated capabilities.
• Shape the strategy for applying advanced analytics, data science, artificial intelligence, machine learning, anomaly detection, and network analytics to identify emerging fraud schemes and improve investigative workflows.
• Identify opportunities to improve detection accuracy, reduce false positives, prioritize high-risk cases, and increase investigator productivity through data-driven and AI-enabled capabilities.
• Translate product strategy into actionable roadmaps, epics, features, requirements, acceptance criteria, and prioritized business outcomes.
• Own the product lifecycle from concept and discovery through design, development, launch, adoption, measurement, and continuous improvement.
• Collaborate closely with engineering, data science, AI/ML, analytics, UX, operations, and Program Integrity subject matter experts to deliver scalable solutions that improve accuracy, efficiency, and user experience.
• Ensure product releases are delivered with appropriate quality, documentation, training, and operational readiness and align with go-to-market objectives.
• Serve as a Program Integrity subject matter expert for customer requirements, business partner integrations, solution architecture discussions, and cross-functional product design.
• Support growth activities including new sales opportunities, renewals, RFP responses, client presentations, product demonstrations, solution workshops, pricing models, and proposal development.
• Partner with sales, marketing, customer success, and go-to-market teams to drive product adoption, client expansion, and market differentiation across Medicaid and other payer organizations.
• Collaborate with the Director of Product on product positioning, packaging, pricing, competitive differentiation, and commercialization strategies.
• Engage directly with clients, investigators, analysts, and Program Integrity leaders to understand operational challenges and translate feedback into product enhancements.
• Define and track product success metrics, including fraud identification effectiveness, detection accuracy, false-positive reduction, investigative efficiency, financial impact, client adoption, and user satisfaction.

Required Qualifications

• 5+ years of experience in product management, product strategy, healthcare technology, business transformation, or a related product leadership role.
• 5+ years of experience in healthcare Program Integrity, including fraud, waste, and abuse detection, investigation, prevention, payment integrity, or related functions.
• Demonstrated experience working with Medicaid programs, Medicaid Management Information Systems, or Medicaid Program Integrity operations.
• Strong understanding of healthcare claims, provider, member, encounter, and related data used to identify potentially fraudulent or abusive behavior.
• Solid understanding of how advanced analytics, network analysis, anomaly detection, predictive modeling, machine learning, and AI can be applied to identify suspicious provider, member, billing, or referral behavior.
• Experience owning product strategy, roadmaps, requirements, prioritization, and end-to-end delivery of complex healthcare technology products or initiatives.
• Ability to translate complex Program Integrity business problems into scalable product capabilities and measurable outcomes.
• Demonstrated ability to work effectively with engineering, data science, analytics, business, sales, and operational teams.
• Experience communicating product strategy and complex technical concepts to both technical and non-technical stakeholders.
• Demonstrated ability to drive measurable client and business outcomes through improvements in fraud detection, investigative efficiency, recovery opportunities, or Program Integrity operations.

Preferred Qualifications

• Product management or Agile certifications such as CSPO, PSPO, SAFe POPM, or equivalent.
• Hands-on experience incorporating AI, generative AI, machine learning, or advanced analytics into product design, development, or product operations.
• Experience launching and scaling products built on data-intensive, cloud-based, analytics, or AI-enabled platforms.
• Experience with healthcare fraud analytics techniques such as provider profiling, peer-group analysis, outlier detection, network/relationship analysis, predictive scoring, and risk-based case prioritization.
• Familiarity with Medicaid claims, encounters, provider enrollment, eligibility, managed care, pharmacy, and other data commonly used in Program Integrity investigations.
• Experience leading client discovery sessions, executive presentations, product demonstrations, workshops, and stakeholder forums.
• Experience supporting RFPs, proposals, demonstrations, pricing, and other pre-sales activities for healthcare technology solutions.
• Experience leading or mentoring product professionals or partnering closely with engineering and analytics leaders to deliver measurable outcomes rather than outputs