Manager, Special Investigation Unit

Job Summary

Managing strategic fraud, waste, and abuse activities, the full-time Manager, Special Investigation Unit will develop and implement compliance measures while leading a remote team to investigate referrals and prepare reports.

Key responsibilities

• Monitor business processes to ensure integrity and compliance in billing and claims payment
• Lead investigations into fraud, waste, and abuse referrals, providing educational materials as needed
• Attend state and federal meetings, review post-payment cases, and prepare saving reports

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, or fraud and abuse
• Thorough knowledge of medical terminology and experience with Dental and Vision plans
• Previous supervisory experience in a managed care environment preferred
• Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred