Manager, SIU Intelligence & Innovation
Core
Leads strategic direction and optimization of Special Investigations Unit (SIU) capabilities to detect, prevent, and investigate healthcare fraud, waste, and abuse using advanced analytics and data assets.
Role type
Manager, Healthcare Fraud Analytics & SIU Strategy
Builds
Proactive anti-fraud detection programs, predictive monitoring capabilities, and actionable intelligence for healthcare integrity.
Domain
Healthcare / Fraud Detection / Data Analytics
Deliverable
production ML models | dashboards & analysis | client delivery
Required skills
Healthcare analytics, fraud detection, team leadership, predictive modeling, data visualization, cross-functional collaboration, regulatory compliance, strategic planning, vendor management, data governance
Preferred skills
Master's degree, Juris Doctor (JD), advanced analytics strategy, AI/ML application, program integrity initiatives
Technologies
HCFS PostShield, AI Shield, Pharmacy Shield, predictive monitoring tools, large healthcare datasets
Responsibilities
Develop and execute SIU proactive anti-fraud detection strategies; manage, mentor, and develop analytics team members; optimize analytics resources and data assets; partner with stakeholders to implement predictive monitoring and reporting solutions; evaluate emerging fraud schemes and industry risks; transform complex datasets into actionable intelligence; lead analytics strategy and SIU transformation initiatives; oversee vendor relationships and performance; represent SIU in enterprise data governance forums; integrate regulatory developments into fraud detection strategies; communicate findings to senior leadership; develop training programs to enhance team expertise.
Seniority
Manager, hands-on leadership & strategy
