Director of Special Investigations

Health Care Service Corporation•Chicago, IL

1d•$121,200 - $225,200•Onsite

About The Position

The Director of Special Investigations will lead the Special Investigations Department (SID) in Texas, Oklahoma, and New Mexico. In addition to directing all healthcare fraud investigations within these states, this position will oversee SID's Enterprise-Wide Intelligence Unit, which is primarily responsible for identifying healthcare fraud schemes. SID's primary mission is to seek the criminal prosecution of individuals and entities that defraud HCSC and its customers. This position will serve as the primary liaison with the FBI, the U.S. Department of Health and Human Services (HHS), and other law enforcement agencies. The Director will also partner with other HCSC departments, including Legal, Medical, and Network, on civil and criminal matters related to SID investigations. Additionally, this position will be responsible for audit and compliance activities related to SID operations. The Director will oversee the development and management of the SID budget and related financial activities for Texas, Oklahoma, and New Mexico.

Requirements

Bachelor Degree.
10 years experience in law enforcement or conducting complex health care fraud or white collar fraud investigations.
4 years of managerial experience.
Administrative and organizational skills.
Clear and concise verbal, written, and interpersonal communication.
Experience developing and maintaining effective liaison relationships.
Translating needs and initiatives into compelling business cases.
Conducting cost-benefit analyses to justify investments and ensure ROI.

Nice To Haves

Experience in the administration of government programs.
Management and administration of health care fraud investigations.
Master’s Degree

Responsibilities

Lead the Special Investigations Department (SID) in Texas, Oklahoma, and New Mexico.
Direct all healthcare fraud investigations within these states.
Oversee SID's Enterprise-Wide Intelligence Unit, responsible for identifying healthcare fraud schemes.
Seek the criminal prosecution of individuals and entities that defraud HCSC and its customers.
Serve as the primary liaison with the FBI, HHS, and other law enforcement agencies.
Partner with other HCSC departments (Legal, Medical, Network) on civil and criminal matters related to SID investigations.
Be responsible for audit and compliance activities related to SID operations.
Oversee the development and management of the SID budget and related financial activities for Texas, Oklahoma, and New Mexico.