Manager, Special Investigation Unit

Manager, Fraud Investigations and Compliance

Remote position - West Coast Time Zone

Pay Rate: $58-$63 per hour

Contract - 3-4 months

Company Overview

The Intersect Group partners with organizations dedicated to improving access, quality, and outcomes in complex service environments. Our client operates one of the largest publicly supported healthcare programs in the country, focused on delivering high quality care to diverse and underserved communities. Their mission driven culture emphasizes accountability, inclusion, and measurable impact across millions of members.

Role Summary

The Manager of the Special Investigation Unit leads investigative operations focused on identifying and mitigating fraud, waste, and abuse across multiple lines of business. This role drives strategic initiatives, oversees investigative staff, and partners with compliance, legal, and external agencies to ensure integrity in claims processing.

You will manage day to day SIU operations, guide high impact investigations, and implement process improvements that enhance detection, recovery, and reporting outcomes. This position plays a critical role in protecting organizational resources, improving operational efficiency, and ensuring regulatory compliance.

Key Responsibilities

• Lead and develop a team of investigators, managing performance, coaching, hiring, and day to day operations

• Oversee fraud investigations across multiple claim platforms, ensuring accuracy, compliance, and timely resolution

• Track and report key performance indicators including recoveries, savings, and investigative outcomes

• Partner with legal, compliance, regulators, and law enforcement on escalated cases and formal investigations

• Drive process improvement and automation initiatives to enhance efficiency and detection capabilities

• Develop and document workflows, policies, and procedures to strengthen investigative operations

• Collaborate with analytics teams to identify trends, risks, and new investigation opportunities

• Support forecasting, staffing strategy, and operational planning to meet business demands

Key Requirements

• Minimum 5 years of fraud investigation experience with at least 3 years in a leadership or management role

• Strong knowledge of fraud, waste, and abuse within healthcare or insurance environments preferred

• Experience managing multiple projects and leading initiatives to successful completion

• Proficiency in Microsoft Excel, Word, PowerPoint, and SharePoint with working knowledge of Visio

• Ability to analyze metrics, identify trends, and translate data into actionable insights

• Bachelor’s degree in Criminal Justice, Law, or related field or equivalent experience

• Strong communication skills with the ability to work cross functionally and present to stakeholders

• Proven leadership skills with a focus on team development, accountability, and performance management

Preferred Qualifications

• Experience in healthcare claims adjudication

• Prior leadership experience managing investigative teams

• Bilingual proficiency in one or more commonly spoken languages in diverse communities

Call to Action

If you are a results driven investigative leader looking to make a meaningful impact, we encourage you to apply today. Please submit your resume along with your contact information to be considered.