Manager, Special Investigations Unit (SIU)

Position Overview: We are seeking an experienced Special Investigations Unit (SIU) Manager to lead healthcare fraud investigation operations and oversee a team of investigators. This individual will be responsible for identifying and addressing suspected fraud, waste, and abuse involving healthcare claims while ensuring investigative quality, operational efficiency, and compliance with applicable regulations. The ideal candidate brings extensive experience inmanaged care fraud investigations, proven people-management skills, and the ability to improve investigative processes while meeting departmental performance goals.

Key Responsibilities: Lead and oversee daily SIU operations, managing investigative staff, case assignments, productivity, quality, and performance metrics. Direct investigations involving suspected healthcare fraud, waste, and abuse, ensuring cases are appropriately reviewed, documented, escalated, and resolved. Establish performance expectations, monitor team results, and provide coaching, training, and professional development to investigators. Manage hiring, onboarding, performance evaluations, employee relations, and corrective action when necessary. Collaborate with legal, compliance, analytics, claims, and other internal departments to identify potential fraud trends and develop investigative strategies. Coordinate with external law enforcement agencies, regulatory authorities, and legal partners on complex or high-priority investigations. Identify opportunities to strengthen fraud detection, improve case review procedures, and enhance investigative outcomes. Develop and implement operational improvements, standardized procedures, workflow documentation, and process automation initiatives. Monitor key performance indicators, financial recoveries, cost savings, quality measures, and overall team productivity. Support workforce planning, resource allocation, budgeting, and operational forecasting. Ensure investigative practices align with organizational policies, regulatory requirements, and applicable industry standards. Communicate investigation findings, operational updates, and recommendations clearly to internal leadership and external stakeholders.

Required Qualifications: At least 5 years of experience managing healthcare fraud investigations, with direct managed care fraud experience required. At least 3 years of supervisory, management, or team leadership experience .Demonstrated ability to oversee investigative operations, manage complex cases, and lead teams toward established performance goals. Strong written and verbal communication skills, including the ability to present findings and communicate professionally with clients and stakeholders. Experience managing multiple projects, priorities, and operational initiatives simultaneously. Working knowledge of Microsoft Excel, Word, PowerPoint, and SharePoint; basic knowledge of Microsoft Visio. High school diploma or equivalent required. A bachelor's degree in Criminal Justice, Law, or a related field is preferred; equivalent education and experience may be considered.

Preferred Qualifications: Experience in healthcare claims adjudication or health insurance claims operations. Experience directly managing and developing a team of fraud investigators. Background working with healthcare plans, managed care organizations, or government-sponsored healthcare programs. Experience collaborating with legal teams, compliance professionals, analytics teams, and external investigative agencies. The selected candidate will receive approximately two weeks of initial training. They are expected to become proficient in the role and independently manage a full workload within approximately 30 days of starting. Success in this position requires strong engagement, accountability, sound judgment, and the ability to maintain productivity while managing competing priorities. Equal Opportunity Statement The employer is committed to providing equal employment opportunities to qualified applicants in accordance with applicable laws and regulations.