Fraud Investigation Manager

Job Summary

A company is looking for a Manager, SIU Prepay Investigations.

Key Responsibilities

• Monitor business processes and systems for integrity and compliance in billing and claims payment
• Lead a team investigating fraud, waste, and abuse referrals for prepay investigations
• Prepare and distribute monthly and quarterly savings reports

Required Qualifications

• Bachelor's degree in Business, Healthcare, Criminal Justice, or related field, or equivalent experience
• 4+ years of experience in medical claim investigation, financial impact analysis, business analysis, compliance, or fraud and abuse
• Thorough knowledge of medical terminology
• Preferred experience as a lead or supervisor managing cross-functional teams
• Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred