Manager - Special Investigations (SIU)

Medica•Minnetonka, MN

15h•Hybrid

About The Position

Medica is a nonprofit health plan serving over a million members across multiple states, focusing on personalized healthcare experiences and strong provider partnerships. We are a collaborative team committed to accountability, data-driven decisions, continuous learning, and celebrating collective success. Our mission is to support our members and employees during significant life moments. This role supervises, trains, and manages the performance of Medica’s Special Investigations Unit (SIU) investigative staff. The position is also responsible for preparing reports and statistical dashboards for SIU business functions. Working with the Director of Special Investigations, this role designs and produces reports on SIU activity for other Medica business units and develops educational communications to promote fraud, waste, and abuse detection and prevention. The Manager - Special Investigations needs to be customer-focused, capable of multitasking, possess extensive knowledge, have strong organizational skills, and thrive in a team environment. They will provide accurate and timely responses to customers. In written communications, this role will proactively collaborate with SIU staff and business segment leadership to identify emerging fraud and abuse patterns and develop strategies to mitigate business impact. The Manager - Special Investigations will use online tools to efficiently identify potential fraud or abuse in claims data. This position requires sensitivity, understanding, and the knowledge to resolve problems quickly. Building strong relationships with leaders in departments such as Compliance, Government Programs, Individual and Family Business, and Operations is crucial. Excellent verbal and written communication and interpersonal skills are necessary for effective collaboration with internal Medica departments and external parties. 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.