Special Investigations Lead

Modivcare is looking for a Special Investigation Unit Lead to be responsible for leading the day-to-day operational needs of the SIU Department under the supervision of the SIU Manager and Supervisor. The Lead, Special Investigations Unit (SIU) is a key contributor to Modivcare's Member Health Plans as well as provider fraud, waste, and abuse (FWA) detection, investigation, remediation, and prevention efforts. The SIU Lead utilizes preliminary data to develop, conduct, resolve, document, and report on tips received, allegations, or data mining output that suggests potentially fraudulent or abusive behavior.

You will...

• Lead investigations in accordance with company policy and regulatory requirements
• Record all findings, results, and data related to investigations in a database and share relevant information with the appropriate supervisors
• Begin investigations into possible fraudulent activity when recommended by analyzing claims, reviewing documents, and evaluating financial records
• Appropriately delegate investigations to the SIU Agents
• Attend and contribute to leadership meetings
• Mentor and monitor SIU Associate activities
• Assist in training and coaching SIU Team in fraud detection and prevention techniques
• Evaluate business operations to identify risk areas for fraud
• Demonstrate a high standard of ethics and promote a culture of compliance
• Design and monitor control systems to reduce the amount of and adverse impact from compliance violations
• Play a key role in supporting timely and accurate client reporting
• Ensure internal policies and procedures comply with regulatory and ethical standards
• Keep abreast of regulatory developments and relevant happenings from governing entities
• Assists in writing and delivering coaching and training to SIU Associates as needed

We are excited to speak to someone with the following...

• High School Diploma or equivalent experience required
• Bachelor's Degree in healthcare, compliance, or related field or equivalent experience strongly preferred
• 2+ years' experience in healthcare compliance or related field preferred
• NHCAA Accredited Health Care Fraud Investigator (AHFI) designation preferred

We value our team members and realize the importance of benefits for you and your family. Modivcare offers a comprehensive benefits package including the following:

• Medical Plans with Prescription Drug Benefits
• Dental Benefits
• Vision Benefits
• Employer Paid Basic Life Insurance and AD&D
• Voluntary Life Insurance (Employee/Spouse/Child)
• Health Care and Dependent Care Flexible Spending Accounts
• Pre-Tax and Post --Tax Commuter and Parking Benefits
• 401(k) Retirement Savings Plan with Company Match
• Paid Time Off
• Paid Parental Leave
• Short-Term and Long-Term Disability
• Legal Services
• Critical Illness, Accident, Hospital Indemnity and Cancer Insurance
• Tuition Reimbursement
• Relocation Services
• Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)

Modivcare. Because we care...always.

5 brands have joined together for one purpose, and we recognized an important need--to improve access to care by addressing the social factors that influence patient health outcomes. Our roots as a logistics leader have laid the foundation for our transformation into a tech-enabled healthcare company making better connections to care.

Salary: $20.32 - 27.09/hour

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

Modivcare requires all employees to be vaccinated for COVID-19. Modivcare is an equal opportunity employer and consistent with federal, state, and local requirements, will consider requests for exemptions from this policy as required under the law.