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AVP, Special Investigations Unit
E-Verify Program. Lead and mentor a team of fraud investigators, analysts, and other staff, providing guidance and support .
About the role
Key responsibilities & impact- Lead and mentor a team of fraud investigators, analysts, and other staff, providing guidance and support
- Collaborate internally with other departments to create and maintain a seamless claims payment integrity program.
- Work closely with analytics teams to contribute to the development of fraud detection strategies using data analytics, machine learning, and other advanced techniques
- Oversee the management of the SIU’s intake and investigative procedures
- Ensure all fraud investigation and prevention activities comply with state, federal, and industry regulations.
Requirements
What you’ll need- Minimum 7+ years of experience in healthcare fraud detection, investigation, or auditing
- Bachelor's degree preferred in healthcare administration, finance, criminal justice, or related field/specialized training/relevant professional qualification.
- In-depth knowledge of healthcare systems claims processing, coding/reimbursement, and regulatory requirements related to healthcare fraud.
- Minimum 5+ years in a leadership role.
- Relevant certifications (e.g., Certified Fraud Examiner (CFE), accredited healthcare fraud investigator (AHFI)
Benefits
Comp & perks- Medical, dental, and vision coverage along with numerous health and wellness programs
- Parental leave and support plus adoption and surrogacy assistance
- Career development programs and tuition reimbursement for continued education
- 401k match including an annual company contribution
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data analyticsmachine learningfraud detection strategiesclaims processingcodingreimbursementinvestigative procedures
Soft Skills
leadershipmentoringcollaborationguidancesupport
Certifications
Certified Fraud Examiner (CFE)accredited healthcare fraud investigator (AHFI)