FICO Insurance Fraud Manager
FICO — Healthcare Fraud & Payment Integrity
Result
Revenue doubled · 27% EBITDA · 7 consecutive losing years reversed
Situation
FICO's Insurance Fraud Manager was an enterprise-class analytics platform scoring over a billion healthcare claim lines per event for some of the largest payers in the country — Anthem (2nd largest US payer), Kaiser, McKesson, CareSource, and Highmark. Despite that scale and client roster, the product had been unprofitable for seven consecutive years. The product was technically capable but the messaging, positioning, and product experience were all misaligned with what the market needed.
Task
Own the full product P&L and turn it around — new product strategy, new go-to-market, complete UI overhaul, and a roadmap that could sustain growth. Seven years of losses meant there was no margin for another partial attempt.
Action
Led a complete UI redesign requiring 75,000+ man-hours across 45 developers and 28+ development personnel, driven by 250+ Agile user stories, a full MRD and PRD — and a lot of late nights. Managed the transition to the corporate cloud platform. Redefined the GTM strategy entirely: shifted the product messaging from 'fraud detection' to 'Payment Integrity,' opening access to new markets and buyer personas that fraud-focused positioning had locked out. Created new collateral, relaunched the product, and rebuilt the competitive positioning and pricing model. Owned the 5-year strategic roadmap and served as the primary external voice for the product with clients, in pre-sales, and at conferences.
Result
Revenue doubled. The product reached 27% EBITDA — ending seven consecutive years of losses. The messaging shift to Payment Integrity opened new markets and redefined how the company competed.
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