Special Investigations Unit (SIU) Manager of Investigations
$107,901–$172,642 year
RemoteUnited States
Job Summary
Oversee case inventory, assign investigations, and drive tactical and strategic direction from intake through resolution for health care fraud, waste, and abuse cases. Review documentation for quality standards, confirm stakeholder referrals, and advise on final case dispositions with counsel. Provide subject matter expertise to team members, develop anti-fraud strategies, and ensure compliance with internal policies and state/federal guidelines. Leverage AI-enabled solutions to improve process efficiency and participate in cross-functional initiatives. Work in a hybrid-flex environment with a starting salary of $107,901.00 - $172,642.00.
Required Qualifications
- Minimum of a Bachelor's degree
- Accredited Health Care Fraud Investigator (AHFI)
- Certified Fraud Examiner (CFE)
- 8+ years of experience conducting/leading healthcare fraud investigations
- Certified Professional Compliance Officer (CPCO)
- Certified Professional Coder (CPC)
- Other Specialty Certifications
- Authorization to work in the United States (E-Verify)
Desired Qualifications
- 10+ years of experience in related field (in lieu of degree)
- Experience leveraging data-driven insights to prioritize investigations, quantify financial impact, and support strategic SIU decision-making
- Data analytics, fraud detection modeling, and interpretation of complex healthcare claims data to identify emerging fraud, waste, and abuse trends
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