Director, Special Investigations Unit

Mass General Brigham Health Plan Holding Company, Inc.

Somerville, Massachusetts, United States
Base: $124,342.40 - $180,897.60/annual; bonus/equi...
Hybrid
Healthcare fraud investigation
Medical billing code analysis
Regulatory compliance auditing
The Director will lead the Special Investigations Unit to prevent, detect, and investigate healthcare fraud, waste, and abuse while ensuring regulatory compliance

Job Summary

  • The Director will lead the Special Investigations Unit to prevent, detect, and investigate healthcare fraud, waste, and abuse while ensuring regulatory compliance.
  • This role involves managing a team of clinical and non-clinical investigators, reviewing complex claims, and coordinating with law enforcement agencies.
  • Mass General Brigham offers competitive salaries, flexible work options, and comprehensive benefits including career growth opportunities in a supportive environment.

Matching Summary

The Director will lead the Special Investigations Unit to prevent, detect, and investigate healthcare fraud, waste, and abuse while ensuring regulatory compliance.

Salary

Base: $124,342.40 - $180,897.60/Annual; Bonus/Equity: Not specified; Benefits: Comprehensive package with flexible work options and career advancement

Skills & Requirements

Must-have

  • Healthcare fraud investigation
  • Medical billing code analysis
  • Regulatory compliance auditing
  • Claims pattern recognition
  • Staff training and supervision

Nice-to-have

  • Strong communication skills
  • Project management expertise
  • Analytical problem solving
  • Diversity equity inclusion focus

Key Requirements

  • Bachelor's degree required; Master's preferred
  • Health care coding certification (CPS or CCS)
  • Accredited Healthcare Fraud Investigator or Certified Fraud Examiner certification
  • 5-7 years experience in insurance audits or investigations
  • 3-5 years management experience in healthcare
  • 6 years experience in health care payer setting

Work Rights

Not specified

Tailored Resume

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