Senior Manager – Special Investigations

Health Care Service Corporation

Senior Manager managing healthcare fraud and internal investigations at HCSC. Leading teams and coordinating with various departments to ensure compliance with regulations and mitigate fraud.

Posted 7/16/2026full-timeChicago • Illinois, Oklahoma, Texas • 🇺🇸 United StatesSenior💰 $92,700 - $167,500 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing healthcare fraud investigations, leading teams of certified coders and analysts, and ensuring compliance with healthcare regulations. Proficient in utilizing data analysis and fraud detection tools to optimize pre-payment review processes and mitigate fraudulent activities.

Highest-signal resume keywords

Healthcare Fraud InvestigationTeam ManagementPre-Payment Review Process ImplementationData AnalysisRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Data AnalysisFraud Detection ToolsPredictive AnalyticsInvestigation TechniquesHealthcare Regulations

Soft Skills

Leadership SkillsOrganizational SkillsAnalytical AbilitiesProblem-SolvingExecutive Communication

Tools & Technologies

MS Office SuiteWorkdayWRIKE

Certifications & Qualifications

Bachelor’s DegreeCertified Professional Coder (CPC)

Industry Keywords

Healthcare ComplianceFraud MitigationLaw Enforcement LiaisonCost AvoidanceProvider Behavior Changes

About the role

Key responsibilities & impact

Manage health care fraud and internal fraud investigations
Manage and train investigators and support staff
Establish and maintain liaison with health care providers and law enforcement
Coordinate anti-fraud activities with other departments at HCSC
Partner with Compliance, Legal, Audit, Provider Services, Clinical Operations, and external regulatory agencies to detect, investigate, and mitigate fraudulent or abusive activities
Ensure compliance with federal and state healthcare regulations
Lead design, implementation, and ongoing optimization of pre-payment review process
Oversee daily volume of claims and monitor program effectiveness through savings, cost avoidance, provider behavior changes, and regulatory compliance metrics
Utilize claims data analysis, predictive analytics, and fraud detection tools to identify suspicious patterns and activities
Manage and develop a team of professional certified coders and investigative analysts

Requirements

What you’ll need

Bachelor’s Degree
10 years law enforcement/investigation experience or healthcare fraud investigation experience
3 years management experience, including supervision of investigators and/or professional certified coders
Organizational skills, results oriented with demonstrated leadership skills
Experience in the implementation of pre-payment review process
Exceptional analytical, problem-solving, and decision-making abilities
Strong executive communication and presentation skills
PC proficiency to include the MS Office Suite (Word, Excel, PowerPoint, Teams) as well as Workday
Preferred: Certified Professional Coder (CPC) designation
Preferred: Experience with WRIKE (SaaS work management process platform)

Benefits

Comp & perks

Health and wellness benefits
401(k) savings plan
Pension plan
Paid time off
Paid parental leave
Disability insurance
Supplemental life insurance
Employee assistance program
Paid holidays
Tuition reimbursement
Other incentives