Director, Special Investigations Unit - AHFI
Core
Lead the Special Investigations Unit (SIU) to develop strategies and oversee investigations into fraud, waste, and abuse (FWA) within a Medicare Advantage and senior care organization.
Role type
Director, Special Investigations Unit
Builds
FWA protocols, investigative case resolutions, and compliance infrastructure for portfolio companies.
Domain
Healthcare / Medicare Advantage / Regulatory Compliance
Deliverable
client delivery
Required skills
Fraud, waste, and abuse (FWA) investigation, regulatory compliance, audit management, vendor oversight, legal inquiry response, risk assessment, stakeholder relationship management
Preferred skills
Risk adjustment, coding expertise, criminal justice specialist knowledge, healthcare compliance certification
Technologies
Investigative tools and technologies (specific tools not named)
Responsibilities
Develop SIU strategies and infrastructure, manage complex investigative cases, conduct FWA training, oversee audit and recovery activities, ensure regulatory compliance, coordinate with federal and state regulators, lead a culture of compliance
Seniority
Director, strategic leadership & team management