Manager of the Special Investigations Unit

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Manager of the Special Investigations Unit is responsible for leading investigative work related to potential fraud, waste, and abuse across health care claims, provider activity, and related operational and/or compliance concerns.

Responsibilities

• Manage day-to-day investigative workflows
• Support the development of staff
• Ensure investigations are conducted thoroughly, consistently, and in alignment with organisational standards and regulatory expectations
• Translate investigative priorities into clear team direction
• Monitor case progress, identify risks, and elevate significant findings to leadership and stakeholders as appropriate

Requirements

• Minimum of two years of experience in health care fraud, waste, and abuse investigations, special investigations, compliance, audit, or a related field
• Minimum of 5 years of investigative work experience
• 3+ years of leadership experience managing or coordinating investigative teams, workflows, and complex case activity
• Strong analytical, problem-solving, and decision-making skills
• Strong written and verbal communication skills, including the ability to summarise complex findings clearly
• Ability to manage sensitive information with professionalism and discretion
• Experience working across cross-functional teams in a regulated environment
• Knowledge of investigative practices, documentation standards, and risk-based decision-making

Preferred Qualifications

• CFE, AHFI, or CPC certification
• Experience with Medicaid investigations and regulatory requirements
• Advanced analytical skills
• Ability to apply critical thinking and sound judgment to complex issues
• Strong ability to think innovatively and develop solutions to improve efficiency, quality, and team performance

Education

• Bachelor’s degree in criminal justice, finance, business administration, or a related field

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs

Pay Range $54,300.00 - $145,860.00