Medicare Claims Technology Product Management Director
CVS Health · Work at Home · $144,200–$288,400 (stated in the posting)
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.
Position Summary
The Lead Director, Technology Product Management for Medicare Claims is accountable for shaping the strategy, roadmap, performance, and modernization of the technology products and platforms that support claims administration for more than 4 million Medicare members.
As the organization transitions to a product operating model, this leader will help establish and mature the product structure, practices, accountabilities, and cross-functional ways of working needed to improve claims accuracy, automation, timeliness, reliability, compliance, and operating efficiency.
The Lead Director will partner closely with business, engineering, data, architecture, operations, and delivery leaders, as well as strategic software vendor partners, to translate claims, regulatory, operational, and technology needs into prioritized investments, aligned roadmaps, and measurable outcomes across a complex enterprise ecosystem.
Given the significant role of vendor-provided platforms in the claims product, this leader will influence vendor roadmaps, align modernization priorities, manage critical dependencies, partner with release management on complex releases, and hold internal and external partners accountable for product performance and business outcomes. This role also leads and develops product management colleagues, strengthens product capabilities, and helps teams evolve from project- and delivery-oriented practices toward sustained accountability for product and business outcomes.
Product Vision, Strategy, and Roadmaps
- Defines and socializes the product vision, strategy and roadmap in collaboration with the 5-in-the-box team; assesses and refines as needed
- Partners with business general manager and stakeholders to make decisions on investment priorities and develop business cases
- Translates customer, business and technology needs into short-term and long-term product strategy by creating Epics/initiatives defined to meet targeted outcomes
- Connects the roadmap to specific value drivers that contribute to business priorities, objectives and key results, and strategic programs
- Responsible for aligning roadmaps, backlogs, capacity, timelines, and commitments across the respective product areas needed to deliver
- Defines product objectives and key results (OKRs), aligned with business objectives, to evaluate progress towards outcomes
Product Backlog Ownership, Work Definition, and Prioritization
- Sets the direction for discovery work, ensuring that the product team is focused on continuous exploration
- Defines roadmap items/epics (with input from other Product Management colleagues and functions who further define features, etc.), identifies dependencies, and works with teams to size ahead of future quarters
- Facilitates product-level ceremonies & meetings, including quarterly PI planning activities (when applicable), in partnership with the product leadership team
Trend Monitoring, Product Performance, and Product Value
- Uses performance data to identify issues quickly, and develop new insights and hypotheses about product health, technical health, and customer feedback
- Tracks product objectives and key results (OKRs), aligned with business objectives, to understand progress towards outcomes and metrics, socializes progress, and consistently reinforces objectives and alignment with broader product portfolio outcomes
- Coordinates product launches, including beta testing, user feedback collection, and product documentation
- Ensures that incremental learnings from product discovery & delivery are prioritized in the backlog.
Cross-Functional Teaming and Stakeholder Management
- Facilitates the “5-in-the-box” cross-functional product leadership team, including strong partnership with Business General Manager (GM)
- Ensures business strategies and targeted outcomes are well understood and socialized to product teams
- Understands market and customer needs through partnership with business & customer insight teams
- Showcases the product teams’ delivery and final output to stakeholders
Grow and Develop the Team
- Understands the hiring market to identify successful candidates with the unique blend of personality and skillset matches
- Champions strong product management and agile mindsets and values by actively communicating team wins and opportunities
- Establishes high performing teams by growing and coaching product management colleagues and defining team norms on how teams working on this product operate
- Responsible for promoting and setting a customer-centric culture where all teams understand the current performance of the product, opportunities areas and the north star vision, and are monitoring and proactively reacting to key product health metrics and communicating updates
Required Qualifications
- 10+ years of relevant experience in digital product management, healthcare technology, claims administration, or related product and technology leadership roles.
- 7+ years of software product management experience, with demonstrated accountability for product strategy and the full product lifecycle from discovery through launch, adoption, and ongoing optimization.
- 5+ years of healthcare payer experience, including significant experience with claims administration products, platforms, operations, or transformation initiatives, and demonstrated knowledge of the end-to-end claims lifecycle, such as benefit interpretation, adjudication, pricing, payment, adjustments, appeals, and financial reconciliation.
- Demonstrated experience directly leading, developing, and coaching product management teams, including establishing clear accountability and building high-performing team cultures.
- Ability to work primarily during Eastern Time business hours and support critical business or production needs when required.
Preferred Qualifications
- Experience with Medicare Advantage claims, including CMS requirements, benefit configuration, provider reimbursement, claims accuracy, payment integrity, and regulatory compliance.
- Demonstrated ability to translate claims business rules, regulatory requirements, operational needs, and performance issues into product capabilities, roadmaps, and measurable outcomes.
- Experience partnering across Claims Operations, Configuration, Provider, Finance, Compliance, Clinical, Engineering, and Data teams to improve claims outcomes.
- Experience leading product strategy and execution for large-scale technology modernization initiatives involving cloud-based platforms, microservices architectures, legacy-system transformation, and complex enterprise dependencies.
- Demonstrated ability to influence senior business and technology leaders, align cross-functional teams, and guide prioritization and investment decisions in a complex, regulated environment.
- Experience managing strategic technology vendor relationships, including roadmap alignment, performance expectations, dependencies, and accountability for outcomes.
- Experience leading product or operating-model transformation within a large, matrixed enterprise.
- Demonstrated use of data, quantitative analysis, and product performance measures to inform decisions and prioritize investments.
- Working knowledge of cloud platforms, modern software architectures, and emerging technologies, including AI and machine learning.
- Product management or Agile certifications
Education
Bachelor's degree or equivalent work experience
Pay Range
The typical pay range for this role is:
$144,200.00 - $288,400.00
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. This position also includes an award target in the company’s equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.