AVP Special Investigations Unit

Job Summary

A company is looking for an AVP, Special Investigations Unit.

Key Responsibilities

• Lead and mentor a team in fraud detection, prevention, and recovery efforts
• Develop fraud detection strategies using data analytics and manage proactive fraud prevention programs
• Oversee investigative procedures, ensure compliance with regulations, and collaborate with law enforcement and regulatory bodies

Required Qualifications

• 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
• In-depth knowledge of healthcare systems claims processing and regulatory requirements
• Minimum 5+ years in a leadership role
• Relevant certifications (e.g., Certified Fraud Examiner (CFE), accredited healthcare fraud investigator (AHFI) are preferred