Job Summary
The Director of the Special Investigations Unit is responsible for formulating and leading comprehensive strategies aimed at preventing, identifying, and probing incidents of fraud, waste, and abuse within the healthcare sector. This role necessitates effective management of investigative teams, supervision of case progressions, and collaboration with various departments to maintain regulatory compliance and assist in financial recovery efforts.
Responsibilities
- Lead the development and implementation of strategies to combat healthcare fraud.
- Manage investigative teams and oversee the entire lifecycle of cases.
- Work alongside different departments to ensure adherence to regulations.
- Facilitate processes for financial recovery related to fraudulent activities.
Qualifications
- A Bachelor’s degree in a relevant field.
- A minimum of 10 years of experience in healthcare fraud, compliance, or investigative roles.
- At least 5 years in a leadership capacity.
- Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) certification is mandatory or to be acquired within one year of hiring.
Amerihealth Caritas provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
