Manager, Special Investigative Unit/ Program Integrity/ CPC - Remote
Core
Manage a team of Special Investigative Unit (SIU) investigators to detect and prevent fraud, waste, and abuse in healthcare claims.
Role type
Manager, Program Integrity & Special Investigations
Builds
Payment integrity operations, pre-payment claim reviews, provider monitoring, and medical record reviews for a commercial health plan.
Domain
Healthcare Payer / Insurance / Compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Team management, regulatory reporting, policy development, compliance advisory, organizational change management, subcommittee leadership, fraud detection, waste detection, abuse detection, pre-payment review oversight, provider monitoring, medical record review, payment integrity operations
Preferred skills
None stated
Technologies
None stated
Responsibilities
Manage a team of SIU Investigators across multiple states; Report findings to government and regulatory agencies; Review and propose updates to health plan rules and policies regarding fraud, waste, and abuse; Provide compliance advice and assist with organizational change; Lead the monthly FWA subcommittee meeting
Seniority
Manager, hands-on leadership
