Dir – Special Investigations Unit
| Company | Corewell Health |
|---|---|
| Location | Grand Rapids, MI, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Expert or higher |
Requirements
- Bachelor’s Degree in criminal justice or other related field, business, health care administration/operations/management, information technology/information security, nursing or other related field
- 10 years of relevant experience in insurance, health care, technology, investigations, and/or law enforcement
- 10 years of relevant experience Supervising/managing people and teams, external delegates and programs
- Knowledge of applicable fraud statutes and regulations, and of CMS guidelines
Responsibilities
- Development, management, implementation and oversight of the Special Investigations Unit
- Overall direction, performance and supervision of the SIU team
- Maintains and revises policies and procedures, fraud, waste, and abuse plans, annual audit work plans
- Drives the development of improvement strategies through the audit process
- Oversees the tracking, reporting, and monitoring of overpayments and recoveries
- Provides direct accountability for SIU case inventory management
- Acts as a catalyst for change and innovation
- Manages external engagements and related requests from federal, state, and local law enforcement agencies
- Motivates others to act by forging positive relationships internally and externally
Preferred Qualifications
- CRT-Accredited Health Care Fraud Investigator (AHFI) – NHCAA National Health Care Anti-Fraud Association Upon Hire preferred
- CRT-Fraud Examiner (CFE) – ACFE Association of Certified Fraud Examiners Upon Hire preferred