Special Investigations Unit Manager

Job Description

We are seeking an experienced and motivated SIU Manager to lead our Special Investigations Unit (SIU) and oversee the organization’s Fraud, Waste & Abuse (FWA) program. This role is responsible for ensuring compliance with regulatory and contractual requirements, managing complex investigations, and developing proactive strategies to prevent and detect FWA across the organization.

Key Responsibilities:

Oversee all functions of the Special Investigations Unit and FWA Program, ensuring compliance with state and federal regulations.

Manage a high-volume caseload involving investigations of fraud, waste, and abuse committed by Medicaid and commercial providers, vendors, and members.

Coordinate with subcontractors on FWA investigations and ensure alignment with company policies and standards.

Interface with internal and external stakeholders to report progress, outcomes, and strategic recommendations on ongoing investigations.

Respond to government and regulatory agency requests for information regarding FWA matters.

Develop and maintain internal controls, education programs, and reporting mechanisms related to FWA.

Identify trends and generate leads for investigations through data analysis and stakeholder engagement.

Support the Director of Controls and Compliance with special assignments related to FWA initiatives.

Required Qualifications:

Education:

High School Diploma or GED OR Bachelor’s Degree.

Experience:

Minimum 8 years of experience in fraud, waste & abuse (FWA) investigations or within a Special Investigations Unit (SIU).

At least 1 year of experience working with Medicaid programs.

Certification (one required):

CPA – Certified Public Accountant (state board of public accountancy)

CFE – Certified Fraud Examiner (Association of Certified Fraud Examiners)

AHFI – Accredited Health Care Fraud Investigator (National Health Care Anti-Fraud Association)

INT-POPC – Intermediate Peace Officer Proficiency Certificate

Prior experience in a Special Investigations Unit within a Health Plan.

Deep understanding of the components, operations, and regulatory requirements of an SIU.

Strong knowledge of FWA trends, medical terminology, and healthcare coding (CPT, ICD-9, ICD-10).

Familiarity with investigative protocols, reporting procedures, and relevant compliance standards.

Ability to exercise independent judgment and effectively leverage resources in fraud detection and investigation.

Exceptional analytical, research, communication, and customer service skills.

Preferred Skills:

Experience working with Medicaid and commercial health plans.

Proficiency in using investigative and case management tools.

Strong collaboration and project management capabilities.Company Description

TruBlu = Tru Results

TruBlu HR Solutions offers premier recruitment services to our clients and candidates for temporary, temp-hire and direct-hire positions.

Whether you are looking for a job or looking for talent, TruBlu delivers results. Our professional consultancy solutions help businesses achieve their long-term employee goals and connect job seekers with positions that build on their experience and expertise.

Our staffing professionals have the industrial, manufacturing, energy and healthcare experience needed to deliver qualified people and talent that will move your business forward. Let us help you identify the best candidates for your team today.

Full-time