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Director of Fraud Waste & Abuse – Special Investigations Unit
Location
Massachusetts
Posted
3 days ago
Salary
$122K - $177K / year
Seniority
Lead
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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