Director of Fraud Investigations

Job Summary

Leading the enterprise-wide Fraud, Waste, and Abuse (FWA) program, the full-time remote Director of Fraud Investigations will manage a team of investigators and analysts, drive strategic program initiatives, and ensure compliance with regulatory requirements across multiple lines of business.

Key responsibilities

• Develops and executes a comprehensive FWA/SIU strategic roadmap aligned with organizational goals and regulatory requirements
• Directs complex investigations involving various stakeholders while ensuring adherence to documentation standards and quality assurance
• Leads a team of investigators, providing coaching and strategic direction to foster a culture of accountability and innovation

Required qualifications

• Bachelor's degree in criminal justice, business administration, healthcare management, or a related field
• At least 10 years of experience in healthcare fraud investigations or compliance, with a minimum of 5 years in a leadership role managing FWA SIU programs
• Certified Fraud Examiner (CFE) or similar certification
• Knowledge of Medicare, Medicaid, and commercial health plan operations
• Ability to analyze complex datasets to identify fraud patterns and support strategic decision-making