About this role

Lead and mentor a team of fraud investigators, analysts, and other staff, providing guidance and support
Collaborate internally with other departments to create and maintain a seamless claims payment integrity program.
Work closely with analytics teams to contribute to the development of fraud detection strategies using data analytics, machine learning, and other advanced techniques
Oversee the management of the SIU’s intake and investigative procedures
Ensure all fraud investigation and prevention activities comply with state, federal, and industry regulations.

Minimum 7+ years of experience in healthcare fraud detection, investigation, or auditing
Bachelor's degree preferred in healthcare administration, finance, criminal justice, or related field/specialized training/relevant professional qualification.
In-depth knowledge of healthcare systems claims processing, coding/reimbursement, and regulatory requirements related to healthcare fraud.
Minimum 5+ years in a leadership role.
Relevant certifications (e.g., Certified Fraud Examiner (CFE), accredited healthcare fraud investigator (AHFI)

Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution

AVP, Special Investigations Unit

Key skills