Director, Special Investigations Unit – SIU
Devoted Health
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $164,000 - $200,000 per year
Job Level
Lead
About the role
- Drive the strategy and results of the FWA program, continuously monitoring performance and proactively stepping into solution mode if key performance indicators (KPIs) indicate improvement opportunities or when issues arise.
- Lead the Annual FWA Risk Assessment and workplan development, ensuring quarterly review and updates are conducted.
- Lead the Special Investigations Unit (SIU) in detecting and investigating suspected FWA in provider behavior, enrollment activity, member activity, and internal operations.
- Develop, implement and maintain comprehensive SIU policies, standard operating procedures (SOPs) and training.
- Manage team performance and provide day-to-day leadership in accordance with KPIs.
- Partner closely with various teams to develop and implement strategies to prevent, detect and correct potential fraud.
- Serve as Chair of the Fraud, Waste and Abuse Sub-Committee which supports the Chief Compliance Officer.
- Work closely with state and federal program integrity organizations.
Requirements
- At least 7 years of experience in healthcare compliance, fraud investigations, law enforcement, or related field
- At least 5 years of experience as a FWA program leader, responsible for oversight and management of a health plan’s SIU and FWA program
- Proven knowledge of CMS, OIG, and DOJ regulatory frameworks governing FWA programs
- Strong investigative skills, with broad fraud investigative experience, including evidence gathering, interviewing, and case documentation
- Demonstrated success in leading complex, multi-party investigations with integrity and discretion
- Excellent communication skills, with the ability to present investigative findings clearly to executives, boards, and regulators
- Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization
- Strong program management abilities with demonstrated competency in strategic planning, training development, and project management
Benefits
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
- And more....
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
healthcare compliancefraud investigationsevidence gatheringinterviewingcase documentationstrategic planningtraining developmentproject managementFWA program managementSIU policies
Soft skills
investigative skillsleadershipcommunication skillsstrategic thinkingintegritydiscretionteam managementcollaborationproblem-solvingpresentation skills