Title: Team Lead, Program Integrity Location: Remote Job Summary: The Team Lead, Program Integrity drives and encourages innovative investigative processes and workflows to reduce turnaround time and produce positive investigative outcomes. Essential Functions: - Direct the day-to-day activities and leadership of investigative staff to ensure goals of the department are met - Serve as investigative planning consultant to investigative teams - Assign cases to investigative staff - Monitor and prioritize investigation allocation to maximize output and effectiveness of staff to ensure requirements and standards are achieved - Identify knowledge gaps and provide training opportunities to direct reports - Lead, arrange and conduct SIU staff meetings - Coordinate the training of new and existing investigative staff to increase recognition of fraud and abuse indicators and properly direct workflows - Mentor direct reports including, coaching, development, performance feedback, disciplinary issues, and annual performance evaluations - Identify workflow and process inefficiencies - Identify, recommend, develop, and implement internal departmental standard operating procedures - Collaborate cross functionally between investigative teams and other matrix partners - Proactively use analytic skills to identify potential areas of FWA and recommend future investigations - Assist department leadership in identifying, planning, and implementing program integrity metrics and performance indicators - Assist department leadership in identifying, planning, and implementing Artificial Intelligence (AI) agents and AI-enabled workflows - Maintain knowledge and stay current on Health Care Fraud trends and schemes - Recommend process or procedure changes and work with cross departmental teams on identified internal system gaps to mitigate FWA or financial risk - Assist in response to state and federal regulatory audits - Identify, assess and control risk to achieve compliance with state and federal integrity rules - Perform investigative case work and contribute to case creation and lead generation - Perform any other job related duties as requested. Education and Experience: - Bachelor's degree in Health-Related Field, Law Enforcement, or Insurance required - Master's degree (e.g., criminal justice, public health, mathematics, statistics, health economics, nursing) preferred - Equivalent years of relevant work experience may be accepted in lieu of required education - Five (5) years of experience in healthcare fraud investigations, medical coding, pharmacy, medical research, auditing, data analytics or related field required - Supervisory or leadership experience preferred Competencies, Knowledge and Skills: - Intermediate proficiency in Microsoft Outlook, Word, Excel, Access, and Power Point - Ability to formally present to a wide audience - Ability to work independently and in a team environment with a high level of confidence - Highest levels of ethics, integrity, ethics and professionalism in performance of all duties - Excellent problem solving and decision-making skills with attention to details - Demonstrated ability in research and drawing conclusions - Ability to perform intermediate data analysis and to articulate understanding of findings - Ability to work under limited supervision with moderate latitude for initiative and independent judgment - Demonstrated leadership skills - Self-motivated and self-directed - Knowledge of government program compliance requirements – Medicare, Medicaid, Affordable Care Act (ACA), etc. - Medical terminology, CPT, HCPCS, ICD codes or medical billing knowledge preferred - Knowledge of medical insurance and/or state regulatory requirements Licensure and Certification: - One of the following certifications is required: Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) required - Certified Professional Coder (CPC) preferred - NHCAA or other fraud and abuse investigation training preferred Working Conditions: - General office environment; may be required to sit or stand for extended periods of time - Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members and may refer members to other CareSource resources. - Travel is not typically required Compensation Range: $72,200.00 - $115,500.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SD1 Brand=CareSource

• Lead, mentor, and coach a team of customer support representatives, providing guidance and support to ensure optimal performance outcomes. • Conduct regular team meetings and provide ongoing training and development opportunities to enhance skills and knowledge. • Ensure that all customer inquiries, concerns, and complaints are addressed promptly and effectively, maintaining the highest levels of customer satisfaction. • Develop and optimize customer service processes and workflows to improve efficiency and productivity. • Analyze metrics and KPIs, such as response times, first contact resolution, and customer satisfaction scores, and take necessary actions to meet or exceed targets. • Prepare regular reports on customer service performance, including key metrics, trends, and customer feedback, and present findings to management. • Identify areas for improvement and implement strategies to enhance customer service operations based on data-driven insights. • Handle employee issues, including performance concerns, conflict resolution, and disciplinary actions when necessary.

Role Description We are on the lookout for a Team Lead who is a client advocate, natural problem-solver, a leader with a track record of driving software development teams to success, and a strategist capable of navigating complex challenges. The ideal candidate thrives within agency environments, fosters collaboration and innovation within their team, and has an extensive track record of consistently delivering high-quality software products to clients. With a strategic mindset and a commitment to excellence, they will ensure our software delivery processes are efficient, effective, and aligned with our organizational goals. Roles and Responsibilities - Client Relationship Management: Act as the primary day-to-day contact for clients throughout the software development lifecycle, ensuring clear communication, managing expectations, and fostering strong relationships. - Software Delivery: Direct the delivery of software products, ensuring they meet the highest quality standards, are delivered on time, and within budget. - Project Governance: Adapt and adhere to project governance frameworks to ensure projects align with organizational objectives and industry best practices. Utilize advanced project management methodologies to guide projects from inception to completion. - Team Development and Management: Lead and inspire a diverse software delivery team, promoting an environment of continuous improvement. - Risk and Change Management: Identify, assess, and mitigate risks associated with software delivery. Manage change and escalate effectively, ensuring minimal impact on project timelines and deliverables. - Continuous Improvement and Innovation: Drive the adoption of best practices in software development and delivery. Champion the use of emerging technologies and methodologies to improve product quality and delivery efficiency. Qualifications - Exceptional leadership abilities with a track record of developing high-performing teams. - Strong commitment to client service and satisfaction. - Demonstrated expertise in applying project management methodologies (e.g., Agile, Scrum, Kanban, Waterfall) to software delivery projects. - Ability to develop and communicate the product vision, strategy, and roadmap. - Skilled in eliciting, documenting, and analyzing requirements. - Excellent verbal and written communication skills. - Proficiency with project management software, requirements management tools, and modern software development environments. - Strong technical background with an understanding of software development life cycles, architectures, and best practices. Requirements - Certification in project management (e.g., PMP, Scrum Master) is highly desirable. - Track record of successfully launching and managing multiple projects throughout their career. - Ability to work closely with technical teams to define, troubleshoot, and resolve complex issues. Benefits - Salary Range: $100,000 - $175,000+ (negotiable based on qualifications, certifications, and experience). - Performance Bonuses. - Free Health Insurance Option for all (Single, 2-Party, and Family). - 401k Safe Harbor Plan. - Profit Sharing Program. - Generous PTO - Maternity / Paternity Leave. - Side Hustle Opportunities. - Certification Reimbursement and Bounty Programs. Other Information - The work hours will be approximately 9:00 am to 5:00 pm EST, depending on workload, with the occasional late night when a tight deadline calls for it. - Background checks will be required due to security-conscious clients. - Position available immediately.

• Own the end-to-end delivery and performance of the pod, including implementations, renewals, and ongoing service work. • Ensure all projects and service requests are completed on time, within scope, and meet established quality standards. • Monitor workloads across the pod and proactively balance resources within the pod and collaborate across teams to meet demand and deadlines. • Leverage data and metrics from ticketing systems to monitor team performance, ensure timely ticket management, and maintain accurate time tracking. • Provide ongoing coaching, mentorship, and development to pod members across all roles in the pod. • Build and maintain strong relationships with aligned B&B offices and key client stakeholders.