Hybrid Director, Fraud Detection – Prevention

Posted 3 weeks ago

Apply now

About the role

  • 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

Director, Fraud Detection – Prevention

Job type

Experience level

Lead

Salary

Not specified

Degree requirement

Bachelor's Degree

Location requirements

Report this job

See something inaccurate? Let us know and we'll update the listing.

Report job