Note: The job is a remote job and is open to candidates in USA. eSense Incorporated is seeking a Program Integrity Product Manager to lead products addressing fraud, waste, and abuse in Medicaid and other payer organizations. The role owns product strategy and lifecycle management while applying analytics, artificial intelligence, machine learning, and related technologies to improve detection, investigations, operational efficiency, and client outcomes.
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
Skills
- 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
- 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
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