Fraud, Waste, and Abuse Program Manager

PacificSource Health Plans

FWA Program Manager at PacificSource implementing and managing fraud prevention strategies. Responsible for ensuring compliance with FWA regulations, reporting, and training.

Posted 7/15/2026full-timeRemote • 🇺🇸 United StatesSeniorLead💰 $83,310 - $145,793 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in designing and managing Fraud, Waste, and Abuse (FWA) programs, with a strong focus on compliance with state and federal regulations. Proficient in data analysis, reporting, and providing strategic recommendations to leadership regarding FWA prevention efforts.

Highest-signal resume keywords

Fraud, Waste, And Abuse InvestigationsPayment Integrity ProcessesData Mining And AnalysisMedicare And Medicaid ProgramsRegulatory Agency Reporting

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Fraud, Waste, And Abuse Program ManagementData AnalysisProcess DevelopmentCompliance MonitoringReporting And Recommendations

Certifications & Qualifications

Fraud Examiner Certification

Industry Keywords

Health Care ClaimsFWA ComplianceState And Federal RequirementsPayment IntegrityInvestigative Processes

About the role

Key responsibilities & impact

The FWA Program Manager will be primarily responsible for the design, implementation, and management of the company’s FWA Program, providing expertise to staff in developing processes for tracking, investigating, and managing suspected FWA complaints.
The role will analyze, report and monitor the FWA prevention efforts and provide recommendations to leadership on matters related to FWA compliance.
The program manager will track and report company activities to ensure compliance with state and federal FWA requirements.

Requirements

What you’ll need

Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims.
Minimum of 4 years of experience implementing or maintaining a fraud, waste, and abuse and payment integrity program in health care.
Experience with regulatory agency reporting and interaction as it relates to fraud, waste, and abuse.
Minimum 4 years of related experience with Medicare and/or Medicaid programs required.
Bachelor’s degree in business, management, health care administration or other related field or Associate’s degree and equivalent work experience required.
Fraud examiner certification preferred.

Benefits

Comp & perks

Flexible telecommute policy
medical, vision, and dental insurance
incentive program
paid time off and holidays
401(k) plan
volunteer opportunities
tuition reimbursement and training
life insurance
options such as a flexible spending account