Manager, SIU Intelligence – Innovation

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Direct the strategic vision, development, and enhancement of SIU capabilities focused on the detection, prevention, and investigation of fraud, waste, and abuse (FWA).

• Promote the use of both internal and external data resources, advanced analytic tools, predictive monitoring techniques, and innovative technologies.

• Collaborate with SIU leadership, Medical Economics, Pharmacy, Compliance, and other enterprise stakeholders to create detection strategies and data-informed insights.

• Supervise analytics personnel, enterprise data projects, modernization initiatives, vendor management, and industry collaborations.

• Assist in planning, developing, and executing proactive anti-fraud detection and analytics programs.

• Oversee, mentor, and cultivate team members, including recruitment, performance management, training, coaching, and resource distribution.

• Enhance analytics resources such as HCFS PostShield, AI Shield, Pharmacy Shield, and other data assets.

• Create and implement analytic methodologies, dashboards, reporting solutions, and predictive monitoring capabilities.

• Assess emerging fraud patterns, industry risks, and analytical opportunities.

• Convert large, intricate datasets into actionable intelligence for lead maturation, investigations, and fraud prevention.

• Support healthcare fraud analytics related to provider, member, pharmacy, and premium-related fraud detection.

• Promote data quality enhancement, data remediation, and cross-functional enterprise and external data initiatives.

• Establish and maintain an SIU analytics roadmap with performance goals, savings objectives, value realization metrics, and operational outcomes.

• Manage analytics-related vendor relationships and oversee performance monitoring.

• Represent SIU in data governance, analytics, innovation, and strategic planning discussions.

• Present analytical findings, trends, risks, and recommendations to senior leadership and stakeholders.

• Lead cross-functional teams in fraud investigations and intelligence activities.

• Keep track of emerging fraud schemes and technological innovations.

• Partner with regulatory bodies and industry stakeholders.

• Oversee the development and implementation of training programs.

• Provide strategic advice to leadership and perform additional responsibilities as assigned.

⛳️ Requirements

• A Bachelor’s degree in Data Analytics, Data Science, Business Analytics, Business or Healthcare Administration, Information Systems, Statistics, Computer Science, Criminal Justice, or a related field, or equivalent experience is required.

• More than 5 years of experience in healthcare analytics, fraud detection, SIU operations, program integrity, payment integrity, healthcare investigations, or related analytical roles.

• At least 2 years of experience in conducting healthcare fraud investigations, with knowledge of trends and schemes related to fraud, waste, and abuse.

• Proven experience in leading, mentoring, coordinating, or managing analytical resources, projects, or teams.

• Demonstrated experience in developing and implementing advanced analytics, predictive monitoring, reporting, data visualization, and fraud detection methodologies using extensive and complex healthcare datasets.

• Experience collaborating with operational, compliance, investigative, and analytics stakeholders.

• Preferred experience in leading healthcare analytics, SIU, Program Integrity, Payment Integrity, Compliance, or FWA initiatives.

• Preferred familiarity with advanced analytics, predictive modeling, artificial intelligence, machine learning, fraud detection technologies, and external data resources.

• A Master’s Degree is preferred.

• A Juris Doctor (JD) is preferred.

• Certifications such as CFE, AHFI, CHC, PMP, SAS, CPC, or related qualifications are preferred.

• Adherence to all policies and standards is required.

🏝️ Benefits

• Competitive salary.

• Health insurance benefits.

• 401K plan.

• Stock purchase options.

• Tuition reimbursement.

• Paid time off along with holidays.

• A flexible work approach with options for remote, hybrid, field, or office schedules.

• Potential for additional incentives.