Director, Special Investigation Unit

The Director, Special Investigation Unit provides management oversight of the investigative team from the planning phase through the disposition of cases within the Special Investigations Unit. The Director ensures the team’s investigative caseload is effectively and efficiently managed, as well as assigned and closed in a timely manner. This position is dedicated to Community’s lines of business (CHIP, Medicaid, Commercial), and oversees all aspects of Fraud, Waste and Abuse within those segments.

QUALIFICATIONS:

• Bachelor’s Degree.
• Certification (Certified Fraud Examiner, or Accredited Healthcare Fraud Investigator). Master’s Degree (i.e., MBA, J.D., Criminal Justice or Forensic Accounting) preferred.
• Seven years of investigative experience (State or local law enforcement, FBI, CIA, DEA, Secret Service, OIG, General Accounting Office, MFCU, government agencies, corporate investigations, insurance company, law firm, accounting firm, auditing or similar professional experience).
• Experience working with Medicare and Medicaid regulations.
• Understanding of healthcare industry, claims processing, investigative process, and auditing.
• Five years in a management position.

Job Type: Full-time

Experience:

• investigative experience (State or local law enforcement, FB: 7 years (Required)
• management: 5 years (Preferred)
• government agencies, corporate investigations, insurance com: 3 years (Preferred)
• working with Medicare and Medicaid regulations.: 1 year (Preferred)

Education:

• Bachelor’s (Required)

Additional Compensation:

• Bonuses

Work Location:

• One location

Benefits:

• Health insurance
• Dental insurance
• Vision insurance
• Paid time off
• Tuition reimbursement