Senior Director Program Integrity And Special Investigations Unit, Geisinger Health Plan

Geisinger

Pennsylvania, United States
Fully remote
Fraud, waste, and abuse prevention
Regulatory compliance
Claims review and analysis
Responsible for the strategic direction, planning, oversight, and operation of the Special Investigations (“SI”) and Program Integrity (“PI”) teams, developing and directing anti-fraud, waste and abuse (FWA) program processes

Job Summary

  • Responsible for the strategic direction, planning, oversight, and operation of the Special Investigations (“SI”) and Program Integrity (“PI”) teams, developing and directing anti-fraud, waste and abuse (FWA) program processes.
  • Ensures all regulatory requirements are met including the completion of annual fraud plans and reports, and acts as a point of contact for collaboration with local, state and federal law enforcement and regulatory partners.
  • Provides leadership and strategic direction of Special Investigations and Program Integrity units spanning all lines of business, and is responsible for Key Performance Indicators including claim edit and claim audit savings.

Matching Summary

Responsible for the strategic direction, planning, oversight, and operation of the Special Investigations (“SI”) and Program Integrity (“PI”) teams, developing and directing anti-fraud, waste and abuse (FWA) program processes.

Skills & Requirements

Must-have

  • Fraud, Waste, and Abuse prevention
  • Regulatory compliance
  • Claims review and analysis
  • Vendor relationship management
  • Team leadership and development

Nice-to-have

  • Collaboration with law enforcement
  • Product strategy support
  • System configuration and maintenance
  • Positive work environment
  • Commitment to diversity

Key Requirements

  • Master's Degree (Required)
  • Bachelor's Degree-Business Administration/Healthcare Management (Preferred)
  • Minimum of 5 years Managerial/Supervisory experience
  • Minimum of 10 years Health Insurance/Managed Care experience

Work Rights

Not specified

Tailored Resume

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