Healthcare Fraud Manager

Job Summary

Leading recovery and accounts receivable operations, the full-time Healthcare Fraud Manager will develop and manage strategic fraud, waste, and abuse activities while overseeing staff and collaborating with cross-functional teams in a remote environment.

Key responsibilities

• Manage outstanding claims recovery and accounts receivable operations, ensuring accountability for inventory and collections
• Lead teams to investigate fraud, waste, and abuse referrals, establishing operational metrics and controls
• Develop customized fraud plans and educational materials to meet contract and federal requirements

Required qualifications

• Bachelor's degree in Business, Healthcare, Criminal Justice, or a related field, or equivalent experience
• 4+ years of experience in medical claim investigation, compliance, or fraud and abuse
• Previous experience in managed care as a lead or supervisor of staff preferred
• Experience managing recovery inventories, receivables, or claims-related financial operations preferred
• Relevant certifications such as Certified Revenue Cycle Representative (CRCR) or Certified Fraud Examiner (CFE) preferred