Manager, Special Investigations Unit

Manager, Special Investigations Unit (Healthcare Fraud Investigations)

Location: Houston, TX (Hybrid - 3 days onsite, 2 days remote)

Schedule: M-F, 8:00 AM - 5:00 PM

Pay Range: $92,8000 - $116,000 / Annually

Employment Type: Full-Time Exempt

Industry: Nonprofit Healthcare Coverage Organization

We are on a mission to create care that's more convenient and professional-with solutions that are value-based and patient-centered. To accomplish this, we are looking for individuals who share our sense of excellence and are ready to embrace new opportunities.

Dean's Professional Services is currently seeking a Manager, Special Investigations Unit (SIU) for a full-time, hybrid opportunity with a nonprofit healthcare coverage organization serving communities across Texas. This is a leadership role focused on rebuilding the SIU department, with direct responsibility over one current team member and four planned hires. The Manager will report directly to the Chief Compliance Officer.

Position Summary

The Manager, Special Investigations Unit (SIU) is responsible for leading a team that investigates and mitigates healthcare fraud, waste, and abuse (FWA) across Medicaid, CHIP, and Commercial lines of business. This role manages case strategy, provider claim reviews, overpayment recovery, regulatory and law enforcement referrals, and staff development. The position plays a key role in rebuilding the SIU department and setting the tone for integrity, efficiency, and strategic compliance.

Key Responsibilities

Lead day-to-day operations of the SIU team, including performance oversight and resource planning

Analyze provider billing patterns, medical records, and claim data to identify potential FWA

Manage vendor relationships and oversee delegated investigative work

Collaborate with internal Legal and Compliance teams and serve as a resource in civil/criminal matters

Build out and train a high-performing team of investigators (total team of 5 once filled)

Design and implement process improvements that ensure compliance with federal/state standards

Promote fraud awareness and provide cross-departmental training

Qualifications

Required:

Bachelor's degree

5+ years of experience in healthcare fraud investigations

3+ years of experience in a leadership/management role within SIU

AHFI, CFE, or similar certification (or ability to obtain within 12 months)

Proficiency in Micro