Boston Medical Center (BMC) logo
Boston Medical Center (BMC)

We’re providing accessible and exceptional care to make a healthier Boston.

Director of Fraud Waste & Abuse – Special Investigations Unit

DirectorDirectorFull TimeRemoteLeadTeam 5,001-10,000Since 1996H1B No SponsorCompany SiteLinkedIn

Location

Massachusetts

Posted

3 days ago

Salary

$122K - $177K / year

Seniority

Lead

Bachelor Degree10 yrs expEnglish

Job Description

Director of Fraud Waste & Abuse – Special Investigations Unit

Boston Medical Center (BMC)

• Leads the enterprise-wide FWA program across Medicare, Medicaid, commercial, and delegated vendor lines of business • Operates with a high degree of autonomy and strategic authority • Drives the design and execution of multi-year program strategy • Advances fraud detection and predictive analytics capabilities • Ensures organizational compliance with applicable federal, state, and contractual regulatory requirements • Delivers measurable impact on organizational revenue protection, program integrity, and risk reduction

Job Requirements

  • Bachelor’s degree in criminal justice, business administration, healthcare management, or a related field
  • At least 10 years of experience in healthcare fraud investigations, compliance, payment integrity, or related field
  • At least 5 years must be leadership experience managing FWA SIU programs and teams in a multistate health plan with diversified product portfolio
  • Certified Fraud Examiner (CFE)
  • Accredited Healthcare Fraud Investigator (AHFI)
  • Certified Professional Coder (CPC)
  • Certified Financial Crimes Investigator (CFCI) or similar certification
  • Knowledge of Medicare, Medicaid, and commercial health plan operations
  • Ability to analyze and interpret complex datasets to identify fraud patterns
  • Skill in developing and implementing fraud detection frameworks

Benefits

  • medical
  • dental
  • vision
  • pharmacy
  • discretionary annual bonuses
  • merit increases
  • Flexible Spending Accounts
  • 403(b) savings matches
  • paid time off
  • career advancement opportunities
  • resources to support employee and family well-being

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