Manager, Special Investigation Unit

Job Summary

A company is looking for a Manager, Special Investigation Unit (SIU).

Key Responsibilities

• Develop, implement, and manage strategic fraud, waste, and abuse activities while ensuring compliance with state and federal requirements
• Lead a team to investigate all potential fraud, waste, and abuse referrals
• Prepare and distribute monthly and quarterly savings reports and develop educational materials on waste activities

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, financial impact analysis, business analysis, compliance, or fraud and abuse
• Thorough knowledge of medical terminology
• Previous experience in a managed care environment and supervisory roles preferred
• Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred