Manager of Special Investigations Unit

Manager of Special Investigations Unit Los Angeles, CA (Remote) 4-Month Contract JPC - 20356 Solugenix is assisting a client, a prestigious health insurance company, in their search for a Manager of Special Investigations Unit. This is a 4-month contract opportunity based out of Los Angeles, CA (Remote). The Manager of Special Investigations Unit (SIU) oversees multi-level staff and processes across multiple lines of business and multiple claim platforms. In addition, this position works closely with external law enforcement officials, internal and external legal or compliance partners on escalated investigations or issues. Day-to-day management includes employee development, expense management, project management, business process improvement, and identifying new investigation opportunities by collaborating with our internal/external analytics partners. This position supports, manages, and escalates the identification of additional suspected fraud of health insurance claims and ensures claims are accurately handled. This team member will also be responsible for providing operational support in reporting, process improvements, coaching, internal quality, day-to-day Key Performance Indicators (KPI’s), and ensuring we meet and/or exceed performance metrics. The Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. Qualifications:

• Bachelors Degree in Criminal Justice, Law, or a related field. In lieu of degree, equivalent education and/or experience may be considered.
• At least 5 years of managing fraud investigations.
• At least 3 years of leading staff or supervisory/management experience.
• Demonstrated ability to manage multiple projects/initiatives and drive them to completion.
• Strong written and verbal communication skills and ability to communicate effectively with a client audience.
• Intermediate working knowledge of MS Excel, Word, PowerPoint, and SharePoint. Basic knowledge of MS Visio.
• Moderate level of metrics and performance, reporting, and understanding of trends and changes.

Preferred:

• Prior experience in a leadership role directly managing a team.
• Experience in health care claim adjudication.

Responsibilities:

• Provide leadership to investigators and be accountable for tracking KPI’s, metrics, recovery, and savings, etc., provides feedback to staff on performance, resolves problems, provides guidance to team members when needed, and takes necessary steps to address poor performance, including corrective action up to termination.
• Manage the day-to-day operations of the SIU by leading a team of investigators, driving key initiatives across the team to improve processes and generate incremental Fraud and Abuse (F&A) opportunities, and executing the overall strategic direction of the SIU.
• Create, implement, and improve operational changes through documentation and process flows that anticipate needs and help in the development of solutions to ensure all needs and issues are addressed promptly.
• Work with multiple cross-functional client's teams and serve as the key resource on complex and critical issues.
• Provide input to forecasting and planning activities for the future state of the business staffing needs and adapt department plans and priorities based on operational needs of the business.
• Direct team members in the area of ideation and vetting new concepts for building additional investigation opportunities or clearer review guidelines for cases.
• Partner with compliance and regulators to make new policy or edits to mitigate fraudulent behavior.
• Work with Law Enforcement and regulators to appropriately support federal and state investigations or provide expert testimony during court proceedings.
• Drive process improvement and automation initiatives to enhance the quality and productivity of outputs.
• Manage staff, including, but not limited to: hiring staff, monitoring of day-to-day activities of staff, monitoring of staff performance, performance reviews, mentoring, training, and cross-training of staff, handling of questions or issues, etc., raised by staff, encouraging staff to provide recommendations for relevant process and systems enhancements, disciplinary matters for direct reports, among others.
• Perform other duties as assigned.

Certification: Accredited Healthcare Fraud Investigator (AHFI certification from National Healthcare Antifraud Association (NHCAA). Pay Range for CA, CO, IL, NJ, NY, WA, and DC: $55/hour to $63.86/hour. Starting rate of pay offered may vary depending Apply tot his job Apply To this Job