• Humana
  • $67,475.00 -132,300.00/year*
  • Deltona, FL
  • Law Enforcement
  • Full-Time
  • 999 4th Ave N

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Description

The Special Investigations Unit Manager leads and monitors investigations of allegations of fraudulent and abusive practices. The Special Investigations Unit Manager works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. Position will also require engagement with governing state Medicaid agencies and assistance with Medicaid compliance reporting , which includes understanding and conducting analysis of MCO contracts.

Responsibilities

The Special Investigations Unit Manager assists coordinating investigation with law enforcement authorities. Leads team/investigators in assembling of evidence and documentation to support successful adjudication, where appropriate.Monitors/Leads investigations toensuring appropriateness of billing practices using a variety of investigational tools. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Required Qualifications

  • Bachelor's Degree in health, criminal justice, or legal related field.
  • 2-4 yrs health insurance claims or Medicaid agencyexperience
  • Excellent PC skills (including MS, Excel and Access) and Powerpointrequired.
  • Excellent communication skills, written and verbal
  • Strong organizational and project management skills
  • Strong Analytical skills
  • Preferred Qualifications

  • Minimum of two years of leadership experience
  • Scheduled Weekly Hours

    40
    Associated topics: crime scene, detective, fingerprint, inspector, investigate, investigation, investigative, investigator

    * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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