Manager, Special Investigation Unit (SIU)
About this role
Manager, Special Investigation Unit (SIU)
Position Purpose: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes.
- Monitor business processes and systems to assure integrity and compliance in billing and claims payment
- Lead a team appropriately investigate all possible fraud, waste and abuse referrals
- Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis
- Attend state/federal meetings as required by specific contracts
- Review post-payment cases with appropriate parties to obtain refund
- Prepare and distribute monthly and quarterly saving reports
- Participate in Appeals Committee, work groups and interdepartmental meetings
Education/Experience:
Read the full description on TalentApply
Create a free account to see the complete job description, how well your CV matches this role, and apply in one click.
AI rewrites and formats your CV so it reads well and gets past screeners.
Get your match percentage for this exact role before you spend time applying.
Send a polished application in one click — no retyping the same details.
Follow every application in one place instead of digging through your inbox.
Free account · No card required
Your next opportunity starts here
Prepare, apply, track, interview and get hired — all from one platform, with AI in your corner.