Top 55 Risk management lead Jobs in Florida

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)
Ultimate Health Plans —Tampa, FL
- From $75,000 a year
- Full-time
- Anatomy knowledge
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Quality and Risk Management Lead
Booz Allen Hamilton —Tampa, FL
- $99,000 - $225,000 a year
- Full-time
- Office
- Master's degree
- Bachelor's degree
- Health insurance
- Flexible spending account
Compliance Risk Management Lead (Governance & Regulatory Exam) - Vice President
JPMorganChase —Tampa, FL
- $128,250 - $195,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Research
- Health insurance
- Tuition reimbursement
4d
CRE Credit Risk Team Lead
Valley National Bank —Tampa, FL
- $113,500 - $200,700 a year
- 7 years
- Microsoft Excel
- Microsoft Outlook
Quick Apply
11d
Finance Risk 1LOD Lead Analyst
Citi —Tampa, FL
- $116,800 - $125,000 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Finance
- Paid holidays
- Disability insurance
Lead Director, Risk Adjustment Performance Reporting and Insights
CVS Health —Florida
- $100,000 - $231,540 a year
- Full-time
- Remote
- Computer Science
- Bachelor's degree
- Mentoring
- Health insurance
- Dental insurance
Supply Chain Risk Management (SCRM) Strategy and Implementation Lead - (Clearance Required)
LMI —Tampa, FL
- $125,000 - $200,000 a year
- Full-time
- Engineering
- Finance
- Bachelor's degree
Lead Director, Medicare Advantage and Group ACA Risk Adjustment Informatics
CVS Health —Florida
- $100,000 - $231,540 a year
- Full-time
- Remote
- Computer Science
- SQL
- Bachelor's degree
- Health insurance
- Dental insurance
Lead Director, Stop Loss Relationship Management
CVS Health —Tallahassee, FL
- $100,000 - $231,540 a year
- Full-time
- Bachelor's degree
- Fair chance
- Experience equivalent to degree accepted
- Health insurance
- Dental insurance
Director - Technical Product Owner/App Development Leader, Development
CITRIN COOPERMAN ADVISORS LLC —Coral Gables, FL
- $165,000 - $250,000 a year
- Full-time
- Computer science
- Computer Science
- 5 years
Partnership & Strategic Initiatives Lead
Quest Corporation of America, Inc. —Tallahassee, FL
- $75,000 - $85,000 a year
- Full-time
- Remote
- 5 years
- Education
- Organizational skills
Director - Cluster Leader/Unified Client Portal, Development
CITRIN COOPERMAN ADVISORS LLC —Fort Lauderdale, FL
- $165,000 - $250,000 a year
- Full-time
- 5 years
- Bachelor's degree
- Senior level
Lead Risk Assessor - Pinellas County & Hillsborough County, Florida
STRUCTION SOLUTIONS —Clearwater, FL
- Contract
- Military
- Mid-level
- Residential
Quick Apply
Accounting Lead
Air Culinaire Worldwide —Tampa, FL
- Full-time
- Microsoft Word
- Microsoft Outlook
- ERP systems
- Health savings account
- Disability insurance
Quick Apply
1d
Senior Workplace Technology Modernization Lead
The Bank of New York Mellon Corporation —Lake Mary, FL
- Full-time
- Computer science
- Microsoft Outlook
- Computer Science
Applications Development Technology Lead Analyst, Vice President
Information Technology Senior Management Forum —Jacksonville, FL
- $113,840 - $170,760 a year
- Full-time
- 5 years
- English
- Office
- Paid holidays
- Disability insurance
Pool Operations & Recreation Lead
BROKEN SOUND CLUB —Boca Raton, FL
- Full-time
- CPR Certification
- Inventory management
- Sanitation
- Paid holidays
- Disability insurance
Quick Apply
Registered Nurse (RN) Team Lead - Operating Room
West Boca Medical Center —Boca Raton, FL
- Full-time
- Nursing
- Surgery
- RN License
- Health savings account
- Health insurance
Technical Delivery Lead - Customer Engagement Solutions, Google Cloud
Accenture —Saint Petersburg, FL
- $87,400 - $266,300 a year
- Full-time
- Hybrid work
- Google Workspace
- 6 years
- Computer Science
- Paid holidays
- Disability insurance
Technical Delivery Lead - Applications, Google Cloud
Accenture —Saint Petersburg, FL
- $87,400 - $266,300 a year
- Full-time
- Hybrid work
- 6 years
- Computer Science
- SQL
- Paid holidays
- Disability insurance

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risk management lead jobs near florida

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)

Ultimate Health Plans -
Tampa, FL

Quick Apply

Job Details

Full-time
From $75,000 a year

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance
401(k) matching

Qualifications

Healthcare financial misconduct investigations
Customer communication
Anatomy knowledge
Microsoft Excel
Investigations regulatory compliance
Microsoft Outlook
Medicare
Managed care
Customer service
Managed care organization experience
Writing skills
Health insurance policy knowledge
Presentations for conferences or internal meetings
Investigative data analysis
Driver's License
Insurance regulation
Healthcare regulatory compliance research
Medicare regulations
Risk management
SharePoint
Medicaid regulations
Medicaid
Healthcare claims compliance audits
Research findings presentation
Medical terminology
Professional development training

Full Job Description

Company Overview

CSTS Customer Service and Technology Solutions LLC is a dedicated third-party administrator specializing in managing the administrative and operational functions for insurance plans. Our mission is to revolutionize the healthcare experience by delivering exceptional products and services to our partners, ensuring compliance and efficiency at every step.

Position Overview

CSTS is seeking an experienced and highly The SIU Lead/Investigator is responsible for supporting the prevention, detection, investigation, reporting (when appropriate), and recovery of money related to health care Fraud, Waste, and Abuse (FWA). The SIU Lead is accountable for managing the day-to-day SIU activities. This position will ensure compliance with federal and state guidance related to FWA, and for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care.

Job Duties

Responsible for developing leads presented to the SIU to assess and determine whether potential FWA is corroborated by evidence.
Claims review for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims.
Lead investigation caseloads, document all case files appropriately to meet regulatory guidelines. Completing investigations within the mandated period of time required by state and/or federal contracts and/or regulations.
Communicate orally and in writing with all customers, internal and external, regarding findings.
Prepare reports to document findings and maintain up-to-date case files for management review.
Collaborate with other departments within UHP and outside vendors to ensure the success of the UHP SIU program.
Provide inter-departmental input regarding controls for preventing and monitoring FWA issues.
Develop strategies to create and maintain a FWA Unit that has the flexibility, knowledge, situational awareness, and capacity to successfully address the dynamic FWA environment.
Provide recommendations or intervention strategies to correct and/or prevent abusive practices, including proposals to recover inappropriately paid monies or to suspend or terminate program participation.
Lead the development and delivery of educational awareness and training programs for the organization and providers.
Maintain outcome-focused SIU Policies & Procedures that are consistent with all applicable contractual and regulatory requirements.
Develop and maintain a high degree of rapport and cooperation with the Federal, State, and local law enforcement and regulatory agencies which can assist in investigative efforts.
Prepares appropriate FWA referrals to regulatory agencies and law enforcement.
Present provider review findings to internal and external entities as requested.
Other duties as assigned

Job Qualifications

Required Education

Bachelor’s degree or associate degree, in criminal justice or equivalent combination of education and experience.

Required Experience/Knowledge, Skills & Abilities

1-3 years of Medicare managed care compliance and/or investigation experience, unless otherwise required by state contract.
Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions.
Knowledge of Managed Care and the Medicaid and Medicare programs.
Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems.
Understanding of datamining and use of data analytics to detect fraud, waste, and abuse.
Proven ability to research and interpret regulatory requirements.
Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels.
Excellent oral and written communication skills; presentation skills with ability to create and deliver training, informational and other types of programs.
Excellent skills in Microsoft Office (Word, Excel, PowerPoint, Outlook), SharePoint and Intra/Internet as well as proficiency with incorporating/merging documents from various applications.
Strong logical, analytical, critical thinking and problem-solving skills.
Initiative, excellent follow-through, persistence in locating and securing needed information.
Fundamental understanding of audits and corrective actions.
Detail-oriented, self-motivated, able to meet tight deadlines.
Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities.
Collaborative and team-oriented

Required License, Certification, Association:

Valid driver’s license required.

Preferred Experience:

At least 5 years of experience in FWA and/or compliance in Medicare managed care organizations is required.

Preferred License, Certification, Association:

Health Care Anti-Fraud Associate (HCAFA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)

CSTS is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Pay: From $75,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Health insurance
Vision insurance

Application Question(s):

How many years of Medicare Advantage experience do you have?
Can you describe your experience with Medicare or Medicaid fraud and waste investigations?
How do you prioritize and manage your workload when dealing with multiple fraud cases at once?

Work Location: In person

Quick Apply

Refine Your Search

risk management lead jobs in florida

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)

Quality and Risk Management Lead

Compliance Risk Management Lead (Governance & Regulatory Exam) - Vice President

CRE Credit Risk Team Lead

Finance Risk 1LOD Lead Analyst

Lead Director, Risk Adjustment Performance Reporting and Insights

Supply Chain Risk Management (SCRM) Strategy and Implementation Lead - (Clearance Required)

Lead Director, Medicare Advantage and Group ACA Risk Adjustment Informatics

Lead Director, Stop Loss Relationship Management

Director - Technical Product Owner/App Development Leader, Development

Partnership & Strategic Initiatives Lead

Director - Cluster Leader/Unified Client Portal, Development

Lead Risk Assessor - Pinellas County & Hillsborough County, Florida

Accounting Lead

Senior Workplace Technology Modernization Lead

Applications Development Technology Lead Analyst, Vice President

Pool Operations & Recreation Lead

Registered Nurse (RN) Team Lead - Operating Room

Technical Delivery Lead - Customer Engagement Solutions, Google Cloud

Technical Delivery Lead - Applications, Google Cloud

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