Director, Special Investigative Unit – SIU

Role Overview

• Oversee a full range of waste, abuse and fraud investigations, audits and medical code editing scenarios
• Ensure all audits adhere to federal and state Medicaid fraud, waste and abuse guidelines
• Oversee the activities of the SIU for accurate and timely operational reviews and final reviews
• Interpret audit results and assist health plan executives in the development of appropriate action plans to address identified risks
• Develop and implement continuous auditing processes from analytic design to final report stage
• Identify and direct the implementation of new technologies
• Ensure compliance with all state and federal regulations for fraud and abuse
• Respond to all legal inquiries including subpoenas and court appearances
• Attend federal CMS and state fraud meetings with other managed care organizations, and state and federal employees

Requirements

• Bachelor's degree in Accounting, Criminal Justice, Finance, Medical Professional, Economics, Operations Management or related field or equivalent
• 7+ years of related compliance and/or special investigation experience in managed care or CMS

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules