Manager, Fraud and Waste • Special Investigations Unit - Medicaid - Remote US

Become a part of our caring community and help us put health first
 The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

The Manager, Fraud and Waste coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Use your skills to make an impact
 

WORK STYLE: Remote/work at home with up to 15% travel possible

WORK HOURS: Core business hours are Monday-Friday, 8 hours/day, 5 days/week.

Required Qualifications

• Bachelor's Degree in health or business related field

• Prior health insurance claims experience

• Demonstrated formal or informal people management

• Excellent PC skills (including MS, Excel and Access) required.

• Excellent communication skills, written and verbal

• Previous operational leadership and/or progressive business consulting experience

• Strong organizational and project management skills

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Up to 10-15% travel (local, regional, national) will be required

Preferred Qualifications

• Minimum of two years of leadership experience

• CFE (Certified Fraud Examiner) or AHFI (Accredited Healthcare Fraud Investigator)

Additional Information

• Benefits starting day 1 of employment 

• Competitive 401k match  

• Generous Paid Time Off accrual  

• Tuition Reimbursement 

• Parental Leave 

WAH requirements: …