Special Investigations Unit (SIU) Manager of Operations
$107,901–$172,642 year
RemoteUnited States
Job Summary
Lead daily SIU operations, including intake, logging, triage, due diligence, and preliminary review of potential fraud, waste, and abuse incidents. Monitor external intelligence channels, manage prepayment intervention operations, and oversee inbound and outbound correspondence related to SIU activities. Establish and drive team performance metrics, production goals, and operational outcomes aligned to organizational priorities. Provide dynamic leadership, coaching, and professional development pathways for team members while serving as a liaison with internal and external partners to develop anti-FWA strategies. Ensure SIU activities comply with contracts, the Company Code of Conduct, and applicable state and federal guidelines. Leverage and develop AI-enabled tools to improve process efficiency and operational effectiveness.
Required Qualifications
- Bachelor's degree
- 8+ years of relevant experience
- Accredited Health Care Fraud Investigator (AHFI)
- Certified Fraud Examiner (CFE)
- Certified Professional Compliance Officer (CPCO)
- Certified Professional Coder (CPC)
- Statistics and Extrapolation
- Authorization to work in the United States
- Hybrid Flex or Remote Flex work arrangement
Desired Qualifications
- 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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