Special Investigations Unit Manager, Fraud and Waste

Humana - Work at Home3.7

Full-timeEstimated: $77,000 - $110,000 a year

The Special Investigations Unit Manager leads and monitors investigations of allegations of fraudulent and abusive practices. The Special Investigations Unit Manager works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. Position will also require engagement with governing state Medicaid agencies and assistance with Medicaid compliance reporting , which includes understanding and conducting analysis of MCO contracts.

The Special Investigations Unit Manager assists coordinating investigation with law enforcement authorities. Leads team/investigators in assembling of evidence and documentation to support successful adjudication, where appropriate. Monitors/Leads investigations to ensuring appropriateness of billing practices using a variety of investigational tools. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Required Qualifications

Bachelor's Degree in health, criminal justice, or legal related field.
2-4 yrs health insurance claims or Medicaid agency experience
Excellent PC skills (including MS, Excel and Access) and Powerpoint required.
Excellent communication skills, written and verbal
Strong organizational and project management skills
Strong Analytical skills
Preferred Qualifications

Minimum of two years of leadership experience
Scheduled Weekly Hours