Sr. Director of Engineering - Fraud

Overview

We are looking for a dynamic and experienced Sr. Director of Engineering to lead our Fraud Division. The Director, Fraud, Waste, and Abuse (FWA) will oversee Cotiviti’s Prospective FWA Services team, inclusive of managers, supervisors, team leaders and corresponding investigators/coders. Through this work, the successful candidate will drive innovation of our Prospective FWA product line to meet the evolving needs of our clients and prospects, including potential new markets. The successful candidate will demonstrate a unique blend of leadership, creativity, business judgment, entrepreneurial spirit, health care industry knowledge and experience, and prospective FWA operational domain expertise.

Responsibilities

• Manage the prospective FWA services team, including our international operations partners.
• Develop standard operating procedures for the prospective team.
• Collaborate with Client Executives, Client Services Managers and FWA Management staff in client and daily operational oversight of the prospective FWA function.
• Work with existing customers and prospects to understand experiences to date and future requirements in a systematic way to develop strategic product responses, rather than on-off client fixes.
• Train and mentor staff managers and provide training related to management and leadership competencies.
• Develop and maintain policies and procedures for operational processes in order to ensure optimization, efficiency and compliance with established standards, regulations and best practices. Promote and socialize best practices in all areas of clinical operations.
• Collaborate with account management, IT, and other applicable departments to ensure client expectations are met. Participate in client meetings and sales calls as subject matter expert for areas of responsibility. Participate in development of SOWs, RFPs, and approve all contract SOW/SLA’s for respective areas prior to execution.
• Oversee the work of Managers, Team leads, Coders, Investigators and/or support staff.
• Ensure compliance with customer contracts.
• Oversee recruiting, hiring, training and orientation of new staff; and assure consistency with ongoing staff training and development.

Qualifications

• Bachelor’s degree in computer science, information technology, or related field of study is required. Master's Degree preferred. 
• 8-10 years experience in health care analytics (fraud, waste, and abuse preferred) including experience in software product management with a preference for healthcare product management experience (experience as a user of health care data analytics technologies is also relevant)
• Exposure to/experience across payer, provider, government, and employer (direct & channel), perspectives a strong plus
• Familiarity with FWA modeling methodologies and other products highly desirable
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