Vaibhav Tyagi

Product Manager @UnitedHealth Group

CA, US

Collaborate with data science teams to define business logic and product requirements for fraud detection models, translating complex scenarios into Python and SQL-based rules that align with healthcare fraud patterns. • Drive the development of BRDs and FRDs by interpreting HIPAA guidelines and anti-fraud regulatory policies into clear technical documentation for cross-functional engineering teams. • Manage and refine ETL workflows in Alteryx and Snowflake to ensure clean, structured data pipelines for 2M+ weekly claim records, supporting machine learning training, model validation, and audit readiness. • Lead the design and delivery of interactive dashboards in Power BI, enabling stakeholders to monitor model performance metrics such as precision, recall, and false alert rates in near real-time. • Facilitate Agile ceremonies (daily stand-ups, backlog grooming, sprint planning) using JIRA and Rally, ensuring alignment between business priorities and technical delivery timelines. • Conduct risk assessments to identify edge cases where fraud models may incorrectly flag legitimate claims, and work with compliance and operations teams to implement human-in-the-loop review mechanisms. • Create detailed process flow diagrams using BPMN standards (MS Visio) to illustrate how AI-generated fraud alerts integrate into the claims adjudication and resolution lifecycle. • Prioritize product backlog items based on stakeholder feedback, fraud trends, and model performance insights to continuously improve fraud detection outcomes. • Support go-to-market planning for internal fraud analytics solutions, ensuring documentation, training, and stakeholder communication are aligned with UHG standards and delivery goals.

Clark University

Master of Business Administration - MBA

Meerut Institute of Technology

Bachelor of Technology - BTech