Business Area: Legal & Compliance
Job Type: Full time
Date Posted: Aug 25 2026
Job Number: 1653404

This job is available in 1 locations

Remote-LA

Keywords

Manager, Special Investigation Unit (SIU)

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Description

Position Purpose: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes.

Key Details: Candidate must reside within the state of Louisiana. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.

Monitor business processes and systems to assure integrity and compliance in billing and claims payment
Lead a team appropriately investigate all possible fraud, waste and abuse referrals
Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis




Attend state/federal meetings as required by specific contracts
Review post-payment cases with appropriate parties to obtain refund
Prepare and distribute monthly and quarterly saving reports
Participate in Appeals Committee, work groups and interdepartmental meetings

Education/Experience: Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience. 4+ years of combined medical claim investigation, financial impact analysis, business analysis, compliance or fraud and abuse experience. Thorough knowledge of medical terminology. Previous experience in managed care environment and as a lead or supervisor of staff, including hiring, training, assigning work and managing performance preferred. Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred.

License/Certification: Medical records or coding license preferred.Pay Range: $87,700.00 - $157,800.00 per

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