Manager of Investigations

Under minimal supervision, the Manager of Investigations is responsible for all client deliverables, oversight of the day-to-day activities of investigation of allegations of healthcare fraud, waste and abuse at Integrity Advantage. Investigations include medical, pharmacy, facility, and dental fraud allegations. This role reports to the VP of Operations. The ideal candidate will excel at building relationships, both internal and external, and be adept at balancing client needs with internal resources to ensure successful outcomes for all parties involved.  This person will be part of a collaborative leadership team that fosters a culture of excellence.

Essentials Duties and Responsibilities

Team Leadership:

• Lead and mentor a team of investigators and analysts in the performance of our obligations to clients to assess, detect, and investigate healthcare fraud, waste and abuse.

• Conduct 30, 60, 90-day reviews for new hires and annual reviews for all investigations staff.

• Assign investigations and projects to team members based on skills and workload.

• Provide regular feedback and conduct performance evaluations.

• Create and conduct FWA-related training to internal staff as well as at industry-related conferences.

• Perform quality reviews to ensure investigative activities are timely, accurate, and in compliance with requirements prescribed by clients and/or regulators.

• Hold staff accountable for client deliverables and conduct performance management in instances where expectations are not met.

• Identify, interview, hire, and train staff.

• Research industry trends and best practices to improve SIU results and maximize results.

• Support case resolution, settlement and legal proceedings as needed, including testifying in court or working with law enforcement to prepare cases for civil or criminal actions.

• Identify opportunities for Investigations Team training that would enhance team skills and Integrity Advantage value in the market.

·         Client Relationship Management:

• Serve as the primary point of contact for all clients.

• Build and maintain strong, long-lasting client relationships.

• Proactively identify client needs, propose, and implement solutions.

·         Contract Management:

Oversee the execution of contract deliverables and timelines.

Monitor and manage contract hours to ensure optimal utilization.

Ensure all contractual obligations are met or exceeded.

·         Reporting and Communication:

• Prepare and present regular status reports to clients.

• Actively facilitate effective communication between clients and internal teams.

• Conduct client meetings to review progress, address concerns, and discuss future needs.

• Maintain confidentiality and discretion in all investigative activities.

• Perform special projects and other duties as assigned.

Required Qualifications

·         Bachelor’s Degree

·         Seven (7) years of healthcare FWA investigations experience

·         Three (3) years’ experience leading or supervising investigative teams

·         Accredited Healthcare Fraud Investigator (AHFI) Certification or Certified Fraud Examiner (CFE) Certification

Knowledge and Skills

·         Strong verbal and written communication skills; demonstrated thorough documentation required

·         Demonstrated ability to collaborate effectively with other business units to accomplish the SIU mission.

·         Ability to ‘read the room’ and apply emotional intelligence during conversations involving clients and staff.

·         Strong knowledge and understanding of investigative and medical review processes.

·         Strong knowledge of medical and dental terminology, CPT, CDT, HCPCS, and ICD codes.

·         Demonstrated ability to interpret and analyze healthcare data and records.

·         Proficiency in the use of technology applications, particularly MS Excel, Word, and others, as necessary.