Special Investigative Unit Coordinator

Independent Living Systems • Miami, FL

1d

About The Position

Independent Living Systems (ILS), along with its affiliated health plans Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for vulnerable populations. The Special Investigative Unit Coordinator oversees and manages investigations related to fraud, abuse, and other compliance issues in the healthcare and social assistance sector. The role ensures investigative activities are thorough, ethical, and consistent with regulatory standards and organizational policies. Acting as a liaison between internal departments, external agencies, and legal entities, the coordinator facilitates information sharing and case resolution. The coordinator leads investigators and ensures timely, accurate documentation, analysis, and reporting to support corrective actions and risk mitigation. The role contributes to organizational integrity, members’ rights, and compliance with healthcare laws and regulations.

Requirements

• Bachelor’s degree in Criminal Justice, Healthcare Administration, Social Work, or a related field; relevant experience may substitute for the educational requirement on a year-for-year basis.
• Minimum of 3 years of experience in healthcare investigations, compliance, or a related area.
• Strong knowledge of healthcare laws, regulations, and compliance standards, including HIPAA and Medicare/Medicaid rules.
• Proven experience managing investigative teams or projects.

Nice To Haves

• Master’s degree in Criminal Justice, Healthcare Administration, Social Work, or a related field.
• Certification in Fraud Examination (CFE) or Healthcare Compliance (CHC).
• Experience working within a Special Investigative Unit or similar healthcare fraud prevention team.
• Familiarity with data analytics tools and investigative software.
• Advanced degree in a relevant field such as Public Health, Law, or Business Administration.
• Demonstrated ability to work collaboratively with law enforcement and regulatory agencies.

Responsibilities

• Demonstrate commitment to the organization’s mission and model ILS Standards of Excellence.
• Manage and coordinate investigations of suspected fraud, waste, and abuse within healthcare programs, ensuring compliance with legal and regulatory requirements.
• Develop and implement investigative plans while maintaining confidentiality and security of sensitive information.
• Supervise, train, and support investigative staff, overseeing performance, case management, and professional development.
• Collaborate with internal departments and external agencies, including compliance, legal, clinical teams, law enforcement, and regulators.
• Prepare detailed reports, track investigative trends, and present findings to leadership, recommending policy or procedural changes to strengthen compliance and risk management.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level