Investigations Manager - Boston, MA(Job Number:703051)
This position will lead a team of auditors in an effort to identify fraud, waste and abuse and meet the program integrity needs of the Commonwealth of Massachusetts. The position is located in Boston, Massachusetts.
The Investigations Manager will be responsible for managing a team that is triaging, investigating and resolving instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. This team will be utilizing information from claims data analysis, plan members, the medical community, law enforcement, employee conduct, and confidential investigations in order to document relevant findings. The Manager and the team members will conduct onsite and desk audits of provider claims and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documentation related to the investigation, and prepare all necessary reports. The Manager and team will input information into Optum audit workflow tools and the Commonwealth’s case tracking system. They will act as a subject matter expert in identifying, communicating and recouping improper payments as deemed appropriate. Where applicable, the Manager and team members will provide appeals and investigative support, as well as testimony.
Job Special Investigation Unit
Primary Location US-MA-Boston
Organization Optum Government Solutions
Number of Openings 1