Director, Special Investigations Unit

621

Somerville, Massachusetts, United States
Base: $124,342.40 - $180,897.60/annual; bonus/equi...
Hybrid
Healthcare fraud detection and investigation
Medical billing and coding analysis
Regulatory compliance and audit reporting
The Director of the Special Investigations Unit at Mass General Brigham Health Plan will oversee investigations related to healthcare fraud, waste, and abuse, ensuring compliance with regulations. The role requires strong leadership, analytical skills, and extensive experience in insurance audits and investigations within the healthcare sector

Job Summary

  • The Director will lead the Special Investigations Unit to prevent, detect, and recover funds related to healthcare fraud, waste, and abuse.
  • This role requires managing a team of clinical and non-clinical investigators while ensuring strict adherence to federal, state, and local regulations.
  • Mass General Brigham offers competitive salaries, flexible work options, and a comprehensive benefits package for high-performing professionals.

Matching Summary

Match Score: 85

The Director of the Special Investigations Unit at Mass General Brigham Health Plan will oversee investigations related to healthcare fraud, waste, and abuse, ensuring compliance with regulations. The role requires strong leadership, analytical skills, and extensive experience in insurance audits and investigations within the healthcare sector.

Salary

Base: $124,342.40 - $180,897.60/Annual; Bonus/Equity: Not specified; Benefits: Comprehensive benefits, career advancement, differentials, premiums, and bonuses

Skills & Requirements

Must-have

  • Healthcare fraud detection and investigation
  • Medical billing and coding analysis
  • Regulatory compliance and audit reporting
  • Team leadership and staff training
  • Claims review and recovery processes

Nice-to-have

  • Strong analytical skills for pattern recognition
  • Excellent communication for external reporting
  • Project management for concurrent audits
  • Commitment to diversity and inclusion
  • Ability to work in a hybrid environment

Key Requirements

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

Work Rights

Not specified

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