Director of Fraud Waste & Abuse – Special Investigations Unit

Boston Medical Center (BMC)

Director of Fraud leading enterprise-wide FWA program across healthcare lines. Ensuring compliance and advancing fraud detection capabilities for organizational risk reduction.

Posted 6/17/2026full-timeRemote • Massachusetts • 🇺🇸 United StatesLead💰 $122,000 - $177,000 per yearWebsite

About the role

Key responsibilities & impact

Leads the enterprise-wide FWA program across Medicare, Medicaid, commercial, and delegated vendor lines of business
Operates with a high degree of autonomy and strategic authority
Drives the design and execution of multi-year program strategy
Advances fraud detection and predictive analytics capabilities
Ensures organizational compliance with applicable federal, state, and contractual regulatory requirements
Delivers measurable impact on organizational revenue protection, program integrity, and risk reduction

Requirements

What you’ll need

Bachelor’s degree in criminal justice, business administration, healthcare management, or a related field
At least 10 years of experience in healthcare fraud investigations, compliance, payment integrity, or related field
At least 5 years must be leadership experience managing FWA SIU programs and teams in a multistate health plan with diversified product portfolio
Certified Fraud Examiner (CFE)
Accredited Healthcare Fraud Investigator (AHFI)
Certified Professional Coder (CPC)
Certified Financial Crimes Investigator (CFCI) or similar certification
Knowledge of Medicare, Medicaid, and commercial health plan operations
Ability to analyze and interpret complex datasets to identify fraud patterns
Skill in developing and implementing fraud detection frameworks

Benefits

Comp & perks

medical
dental
vision
pharmacy
discretionary annual bonuses
merit increases
Flexible Spending Accounts
403(b) savings matches
paid time off
career advancement opportunities
resources to support employee and family well-being

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

fraud detectionpredictive analyticsdata analysisfraud detection frameworkspayment integrityrisk reductionprogram strategy designcompliance managementhealthcare fraud investigations

Soft Skills

leadershipstrategic authorityautonomyorganizational compliancecommunication

Certifications

Certified Fraud Examiner (CFE)Accredited Healthcare Fraud Investigator (AHFI)Certified Professional Coder (CPC)Certified Financial Crimes Investigator (CFCI)