Job Description

Special Investigations Unit Manager

The Special Investigations Unit (SIU) Manager is responsible for overseeing fraud, waste, and abuse (FWA) prevention, detection, investigation, and recovery activities in accordance with applicable regulatory, contractual, and organizational requirements. This role leads investigative efforts, manages case workflows, identifies recovery opportunities, supports regulatory reporting, and collaborates with internal and external stakeholders to protect organizational assets and ensure program integrity.

Key Responsibilities

• Manage and oversee fraud, waste, and abuse investigations from intake through resolution.
• Ensure compliance with applicable federal, state, contractual, and organizational requirements related to program integrity and investigations.
• Conduct data analysis and data mining activities to identify potential fraud, waste, and abuse risks and investigative opportunities.
• Analyze billing, claims, payment, and operational data to identify unusual patterns, trends, or potential misconduct.
• Conduct interviews and gather evidence from providers, customers, vendors, witnesses, and other relevant parties.
• Prepare investigative findings, audit reports, recovery recommendations, and regulatory submissions.
• Coordinate investigative activities with external vendors, business partners, regulatory agencies, and law enforcement organizations as appropriate.
• Collaborate with Compliance, Legal, Finance, and Operational teams to support investigations and corrective actions.
• Monitor overpayment recovery opportunities and support recovery efforts.
• Interpret and communicate regulatory requirements, contractual obligations, and investigative findings to internal and external stakeholders.
• Maintain detailed case documentation and ensure timely, accurate reporting.
• Perform additional duties and special projects as assigned.

Qualifications

Required

• Bachelor's degree or equivalent combination of education and experience.
• 5–7+ years of experience in program integrity, fraud investigations, compliance, audit, risk management, or a related field.
• Strong analytical, investigative, and problem-solving skills.
• Ability to manage multiple priorities independently with minimal supervision.
• High level of integrity, professionalism, and discretion when handling confidential information.
• Strong verbal and written communication skills.
• Advanced proficiency with Microsoft Office applications, including Excel.

Preferred

• Experience investigating fraud, waste, abuse, financial misconduct, or regulatory compliance matters.
• Knowledge of claims processing, payment systems, audit methodologies, or reimbursement practices.
• Familiarity with regulatory investigations, recovery initiatives, and enforcement trends.
• Professional certifications such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Internal Auditor (CIA), or similar credentials.

Skills & Competencies

• Investigative interviewing and fact-finding
• Data analysis and pattern recognition
• Regulatory compliance and risk assessment
• Documentation and report writing
• Time management and prioritization
• Stakeholder collaboration and relationship management
• Attention to detail and organizational skills
• Results-oriented decision making

Work Environment

• Hybrid office environment with occasional travel to meetings, investigations, training events, or business locations.
• Standard business hours with flexibility based on operational needs.
• Moderate noise level typical of a professional office setting.