Manager, Special Investigations Unit
Core
Leading investigative work related to potential fraud, waste, and abuse across health care claims, provider activity, and related operational and/or compliance concerns.
Role type
Manager, Special Investigations Unit
Builds
Investigative workflows and case outcomes for health care claims and provider activity
Domain
Health care / Compliance / Fraud Investigation
Required skills
Health care fraud, waste, and abuse investigation; Team leadership; Analytical rigor; Regulatory compliance knowledge; Risk-based decision-making; Cross-functional collaboration
Preferred skills
CFE, AHFI, or CPC certification; Medicaid investigation experience; Advanced analytical skills; Innovative problem-solving
Technologies
N/A
Responsibilities
Manage day-to-day investigative workflows; Support staff development; Ensure investigations align with organizational standards and regulatory expectations; Translate priorities into team direction; Monitor case progress; Identify risks; Elevate significant findings to leadership
Seniority
Manager, hands-on leadership
