Manager, Special Investigation Unit – SIU

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

📋 Description

• Create, execute, and oversee strategic initiatives to combat fraud, waste, and abuse.

• Ensure adherence to both state and federal regulations while tracking emerging trends and schemes.

• Evaluate business processes and systems to guarantee integrity and compliance in billing and claims payments.

• Lead a team in the thorough investigation of all potential fraud, waste, and abuse referrals.

• Design educational resources to highlight and address wasteful activities.

• Attend relevant state and federal meetings as mandated by specific contracts.

• Review post-payment cases with relevant parties to facilitate refunds.

• Compile and distribute monthly and quarterly reports on savings.

• Engage in Appeals Committee, work groups, and interdepartmental meetings.

⛳️ Requirements

• A Bachelor’s degree in Business, Healthcare, Criminal Justice, or a related field, or equivalent professional experience.

• A minimum of 4 years of experience in medical claim investigation, financial impact analysis, business analysis, compliance, or fraud and abuse.

• Comprehensive understanding of medical terminology is essential.

• Prior experience in a managed care setting as a lead or supervisor, including responsibilities in hiring, training, assigning work, and managing performance is preferred.

• Familiarity with Microsoft Excel, medical coding, claims processing, and data mining is advantageous.

• A medical records or coding license is preferred.

🏝️ Benefits

• Competitive pay

• Health insurance

• 401K plan

• Stock purchase plans

• Tuition reimbursement

• Paid time off plus holidays

• Flexible work options, including remote, hybrid, field, or office schedules

• Additional forms of incentives may be included in total compensation