Manager - Special Investigations (SIU)

Medica•Minnetonka, MN

1d•$78,700 - $118,020•Hybrid

About The Position

This position is responsible for supervising, training, and the overall performance of Medica’s Special Investigations Unit (SIU) investigative staff. Additionally, this position is responsible for the preparation of reports and statistical dashboard for all Special Investigation Unit (SIU) business functions. This position works collaboratively with the Director, Special Investigations to design and produce reports on SIU activity for other Medica business units, as well as develop educational communication to raise awareness of fraud, waste and abuse detection and prevention at Medica. The Manager - Special Investigations must be customer focused, able to multitask, retain a large amount of knowledge, have strong organizational skills and enjoy working in a team environment. This individual will respond to customers with a high level of accuracy and timely follow-up. In written responses, the Manager must work proactively with SIU staff and business segment leadership to anticipate emerging patterns of fraud and abuse and collaborate to develop strategies to reduce any business impact to Medica. Manager - Special Investigations will utilize online tools and resources to efficiently and effectively identify potential fraud or abuse in claims data. This position requires sensitivity and understanding plus the knowledge and resources to quickly resolve problems. This position is responsible for building solid relationships with leaders in other departments (Compliance, Government Programs, Individual and Family Business, and Operations). Excellent verbal and written communication and interpersonal skills are required to effectively collaborate with other internal Medica departments as well as external parties. Performs other duties as assigned.

Requirements

Bachelor's degree or equivalent
5 years of healthcare, insurance or law enforcement investigative experience
2 years of leadership experience

Nice To Haves

Excellent verbal and written communication skills
Have excellent interpersonal skills and the ability to handle ambiguity
Analytical/Problem Solving and presentation skills
Organized/Able to Multi-Task
Highly Motivated/Self-Starter
Customer Focused
Working knowledge of regulatory enforcement environment
Ability to identify, trend and analyze data for communication and process improvements
Proficient with Microsoft Office Suite

Responsibilities

Manage performance and hold staff accountable for meeting department standards for quality, turnaround time, and attendance. Formulate action plans for substandard performance
Conduct regular one on ones with team members
Establish annual goals and objectives for the team, ensures quarterly check-in’s are completed, prepare and present Performance Reviews
Clearly communicates team and individual expectations
Ensure all team members have the training and tools they need to perform the job successfully
Collaborate with leaders and others as appropriate within the organization to ensure consistent, effective and timely communication and problem resolution
Coach, encourage and facilitate individual growth and development through specific, timely, and consistent feedback. Promote a coaching culture
Backup and support SIU Director, as needed, in various meetings, projects and work groups
Provide technical support to staff by researching and responding to their questions. Provide insight and offer suggestions/solutions to team issues
Review incoming referrals and as appropriate assign for investigation and follow-up
Review investigations closed by investigative staff to ensure that the investigation was thorough and investigative outcome is appropriate
Produce a monthly statistical dashboard of investigative activity for distribution to segment leaders
Prepare monthly, quarterly and annual SIU investigation summary reports for various internal Medica compliance committee meetings, Medica’s Board of Directors and Medica leadership