Financial Crimes Audit Team Lead overseeing audit engagements addressing key risks and compliance. Ensuring effective oversight of financial crimes - related regulations and practices.
About the role
- Director of Fraud Detection & Prevention leading fraud investigations in healthcare organization. Developing prevention programs and ensuring compliance with regulations while managing the Special Investigations Unit.
Responsibilities
- Develop and implement a comprehensive FWA prevention and detection program across the organization
- Lead investigations into suspected fraud, waste, or abuse, ensuring timely resolution and appropriate corrective actions
- Draft, revise, and enforce FWA-related policies and procedures
- Design and deliver targeted training programs for high-risk departments and roles
- Develop dashboards and KPIs to monitor FWA trends and program effectiveness
- Leverage predictive analytics, AI tools, and forensic software to proactively detect anomalies and suspicious patterns
- Establish and maintain reporting mechanisms for suspected FWA, including anonymous hotlines and digital platforms
- Monitor industry trends, regulatory changes, and geopolitical risks that may impact FWA exposure
- Conduct risk assessments and data analytics to identify patterns and vulnerabilities
- Oversee training and awareness programs to educate employees on FWA policies and ethical conduct
- Prepare detailed reports for executive leadership
- Ensure compliance with federal, state, and industry-specific regulations (e.g., HIPAA, CMS, DOJ guidelines)
- Monitor emerging threats and trends in fraud and abuse, adapting strategies accordingly
- Other duties as assigned
Requirements
- Bachelor’s degree required, preferably in a business-related field
- 7–10 years of experience in healthcare fraud investigations or regulatory compliance
- Experience with case management systems, forensic tools, and data analytics platforms
- Experience managing cross-functional teams and external audits
- Excellent organizational skills
- Ability to multi-task and set priorities in a fast-paced environment
- Ability to handle confidential information in a professional manner
- Ability to make solid judgment calls
- Conduct all activities in an organized, timely and responsible manner
- Ability to gain and maintain knowledge of all department responsibilities preferred
- Proficiency with MS Office Suite
- Excellent time management skills
- Ability to work within a team-oriented environment
- Ability to identify, interpret and communicate business risks
- Ability to lead, coach and motivate a specialized compliance team
- Detail oriented, with excellent communication skills
- Data analysis and interpretation skills
- Ability to schedule, organize and prioritize multiple tasks
- Excellent problem-solving skills with the ability to anticipate and resolve problems
- Ability to maintain positive attitude and team focused during high stress situations
- Ability to maintain high level of confidentiality
- Strong understanding of Medicare, Medicaid, and commercial insurance programs
- Familiarity with whistleblower protections and internal control
- Deep understanding of regulatory frameworks and enforcement mechanisms
- Master’s degree in a related field a plus
- Professional certifications such as CFE (Certified Fraud Examiner), CIA, or similar strongly preferred.
Benefits
- Health and Life Insurance Plans
- Dental and Vision Plans
- 401(k) with a company match
- Paid Time Off and Holiday Pay
- Maternity/Paternity Leave
- Casual Dress Environment
- Tuition Reimbursement
- MTM Perks Discount Program
- Leadership Mentoring Opportunities
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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