Director, Special Investigations Unit
The Director will direct the activities of the SIU The director is responsible for developing and executing an enterprise wide strategy to support the prevention, detection, investigation, reporting of fraud, waste and abuse. The candidate will develop and implement short and long-term strategies by designing and building related processes, including identification and investigation of suspicious activity involving allegations of misconduct by providers, members, employees and others on a day-to-day basis. The position is also responsible for ensuring all necessary regulatory requirements are being met with respect to the Company’s fraud fighting and anti-fraud efforts, including the filing of fraud plans and annual reports, other regulatory reports and facilitating state mandated anti-fraud training for employees.
Requirements for the Role:
- Capable of reviewing and enhancing operational processes
- Ability to quickly identify and generate solutions for potential obstacles
- Develops innovative solutions and enhancements to reduce organizational gaps and improve processes
- Identify and seize opportunities to automate, streamline and continuously improve processes
- Ability to achieve goals using new, original or unconventional ideas
- Strong business acumen and ability to quickly pivot strategies as needed to drive results
- Influence and assist business owners in developing process, policies, controls and metrics that ensure compliance with relevant laws, regulations, policies and standards
- Influence others in the development of processes, policies, controls and metrics to ensure compliance with relevant laws, regulations, policies and standards
- Build internal customer relationships in order to serve as a subject matter expert resource
- Strong interpersonal, communication and team skills with the ability to work and communicate effectively with all levels of management and senior leadership
- Experience utilizing a Governance, Risk and Compliance (GRC) tool
- Knowledge and use of project management tools
What We’d Like From You:
- A resume and/or LinkedIn profile
- A short cover letter, please!
Please see complete job description online.
How to Apply: