Director, Special Investigations Unit

Job description

Job Description As the Director, Special Investigations Unit, you’ll set the vision and lead an enterprise SIU focused on protecting members and the organization by preventing, detecting, investigating, and resolving fraud, waste, and abuse (FWA). You will build and develop high-performing teams with the right investigative, clinical, and analytic skill sets; modernize capabilities through advanced analytics and enabling tools; and strengthen end-to-end processes to keep pace with an evolving healthcare fraud landscape. You’ll also shape strategy and operating rhythms that ensure the SIU remains agile, informed, and execution-ready—bringing the insight, situational awareness, and capacity needed to deliver timely, high-quality outcomes in a dynamic FWA environment. What You’ll Do: Establishes and operationalizes SIU strategic plan that positions the SIU to successfully function in the continuously evolving changing health care arena; Leads an organization that effectively identifies sources of FWA, swiftly investigates actionable cases, and effectively creates resolutions that protect the company’s assets; Oversees the SIU staff comprised of analysts, investigators, nurses, and dat...