Senior Manager, Medical Fraud Investigation

Job Summary

A company is looking for a Senior Manager, Major Case Investigative Unit (Medical & Provider Fraud).

Key Responsibilities

• Oversee strategy and handling of complex cases involving multiple claims and parties
• Direct projects and initiatives related to major case and provider fraud
• Lead and develop a collaborative team focused on efficient investigations and employee engagement

Required Qualifications

• 5+ years of leadership experience in P&C Insurance, specifically in First Party Medical claims or Medical SIUs
• Deep expertise in medical provider fraud and related schemes
• Extensive experience managing claims and fraud investigations in high-risk jurisdictions (NY, MI, NJ, FL)
• Bachelor's degree or equivalent experience required
• Ability to obtain and maintain insurance licenses in several states within three months