Director of Fraud Waste & Abuse – Special Investigations Unit

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Oversees the enterprise-wide Fraud, Waste, and Abuse (FWA) program across Medicare, Medicaid, commercial, and delegated vendor business lines.

• Functions with a significant level of independence and strategic authority.

• Leads the development and implementation of a multi-year program strategy.

• Enhances capabilities in fraud detection and predictive analytics.

• Guarantees organizational adherence to relevant federal, state, and contractual regulatory standards.

• Achieves measurable outcomes in organizational revenue protection, program integrity, and risk mitigation.

⛳️ Requirements

• Bachelor’s degree in criminal justice, business administration, healthcare management, or a related discipline.

• Minimum of 10 years of experience in healthcare fraud investigations, compliance, payment integrity, or a related area.

• At least 5 years of leadership experience managing FWA Special Investigative Unit (SIU) programs and teams within a multistate health plan featuring a diversified product portfolio.

• Certified Fraud Examiner (CFE).

• Accredited Healthcare Fraud Investigator (AHFI).

• Certified Professional Coder (CPC).

• Certified Financial Crimes Investigator (CFCI) or a comparable certification.

• Familiarity with Medicare, Medicaid, and commercial health plan operations.

• Proficiency in analyzing and interpreting complex datasets to detect fraud patterns.

• Expertise in developing and implementing fraud detection frameworks.

🏝️ Benefits

• Medical coverage.

• Dental insurance.

• Vision benefits.

• Pharmacy benefits.

• Discretionary annual bonuses.

• Merit-based salary increases.

• Flexible Spending Accounts.

• 403(b) retirement savings match.

• Paid time off.

• Opportunities for career advancement.

• Resources available to support the well-being of employees and their families.