Product Manager – Fraud, Waste & Abuse

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $103k - $128k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

✅ Product Manager

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

Healthcare Insurance • Fintech • Artificial Intelligence

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Define the product strategy and roadmap • Deliver product market requirements documents with prioritized features and corresponding justifications • Work with external third parties to assess partnerships and licensing opportunities • Be an expert with respect to the competition • Develop the core positioning and messaging for the product • Perform product demos to customers • Collaborate with Marketing to develop sales tools • Propose an overall budget to ensure success • Briefly train the sales force at quarterly sales meetings • Act as a leader within the company • Collaborate with analytics and AI/ML teams to enhance product capabilities, including rules-based detection, provider scoring, and advanced data insights that identify aberrant billing behaviors • Balance competing priorities across stakeholders, manage trade-offs, and ensure alignment between strategic goals and execution. • Contribute to the evolution of integrated offerings (e.g., prepay and postpay solutions) to deliver a cohesive, end-to-end fraud detection and payment integrity platform • Provide domain expertise in fraud, waste, and abuse workflows, including provider investigations, case management, and recovery processes. • Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is able to assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction.

🎯 Requirements

• Bachelor’s degree in Business, Computer Science, or other field demonstrating technical expertise. • Previous experience in healthcare FWA preferred. • 3-5+ years of Product Management experience required. • Strong analytical and product management skills required, including a thorough understanding of how to interpret client business needs and translate them into application and operational requirements. • Demonstrated success defining and launching web based services and products. • Excellent verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts. • Experience with Kanban preferred. • Experience with AI and/or Machine Learning initiatives preferred. • Technical background, with experience in software development. • Proven ability to influence cross-functional teams without formal authority. • Proficiency in Microsoft Excel, Microsoft Access, Database interaction capabilities. • Medicare Advantage or other healthcare experience preferred. • National Heath Care Anti-Fraud Association - Certified Accredited Health Care Fraud Investigator preferred.

🏖️ Benefits

• medical, dental, vision, disability, and life insurance coverage • 401(k) savings plans • paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.