Manager, Special Investigations Unit (SIU)
The Manager, SIU will provide management and oversight to investigative teams within SIU and will be accountable for all investigations conducted by his/her team and will provide oversight and approval of the investigations from the planning phase through the disposition. This Manager will also be responsible for ensuring the team’s investigative case load is effectively and efficiently managed and cases are assigned and closed in a timely manner. This position is dedicated to Community’s lines of business (CHIP, Medicaid, Commercial), and will oversee all aspects of FWA within those segments.
• Bachelor’s degree in Accounting or Business Administration required.
• Certified Fraud Examiner, or Accredited Healthcare Fraud Investigator, required.
• Graduate degree and certifications (i.e., MBA, J.D., Masters in Criminal Justice, Masters in Forensic Accounting) preferred.
• Five years of investigative or related experience (State or local law enforcement, FBI, CIA, DEA, Secret Service, OIG, General Accounting Office, MFCU, government agencies, corporate investigations, insurance company, law firm, accounting firm, auditing or similar professional experience, required.
• Experience working with Medicare and Medicaid regulations, understanding of healthcare industry, claims processing, investigative process, and auditing a plus!
In addition to a highly competitive salary with day-1 benefits, Community Health Choice offers:
• Bonus pay
• 401(k) with company match up to 5% and employee catch up contributions up to 75%
• Flexible spending accounts
• Tuition reimbursement
• Continuing education assistance
For immediate consideration, please email resume to: Martha Jones, Sr. Talent Acquisition Partner Martha.Jones@CommunityHealthChoice.org
About Community Health Choice:
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
• Improving Members’ experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers. Equal opportunity employer.