Manager, Fraud and Waste - Remote

Overview

The Special Investigations Unit Manager leads and monitors investigations of allegations of fraudulent and abusive practices within health insurance, ensuring compliance with regulations and effective management of resources.

In Short

• Lead investigations of fraud and waste in health insurance.
• Coordinate with law enforcement authorities as needed.
• Prepare complex investigative and audit reports.
• Ensure appropriateness of billing practices.
• Manage a team of seasoned professionals.
• Requires cross-departmental collaboration.
• Work remotely with 15-20% travel required.
• Regular business hours in Eastern Standard Time (EST).
• Competitive salary and benefits from day one.
• Utilize advanced technical knowledge to solve problems.

Requirements

• Bachelor's Degree required.
• Minimum of 3 years in health insurance claims or Medicare experience.
• 3 years of experience with Fraud, Waste, and Abuse in Managed Care.
• Proven leadership skills.
• Excellent PC skills, especially in MS Excel, Access, and PowerPoint.
• Strong communication and organizational skills.
• Ability to analyze large amounts of data.
• Passion for improving consumer experiences.
• Certifications preferred (BA, MBA, J.D., etc.).
• Understanding of healthcare industry and claims processing.

Benefits

• Benefits starting day 1 of employment.
• Competitive 401k match.
• Generous Paid Time Off accrual.
• Tuition Reimbursement.
• Parent Leave.
• Well-being perks through Go365.
• Support for work-from-home requirements.
• Short-term and long-term disability insurance.
• Medical, dental, and vision benefits.
• Life insurance and other opportunities.