Point32Health

Manager, SIU Provider Investigations

Canton, MA

Sponsorship not specified$105k-$158kDetected 5 days ago

CommunicationMentoring

About the role

Point32Health is currently seeking highly motivated individuals to join our organization as a Manager within our Special Investigations Unit ("SIU").
The Manager is an essential team member of the SIU, responsible for supervising, and setting investigative strategies and priorities for a team of investigators focused on provider investigations.
/Duties - what you will be doing (top five):

Retains own caseload of high complexity investigation
Works closely with the Director, SIU to develop, implement, and revise Point32Health's investigative strategies, processes, and priorities, and effectively deploy investigators to meet those priorities
We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Must be able to work under normal office conditions and work from home as required.
May be required to work additional hours beyond standard work schedule
They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position.

Represents the SIU on various internal working groups and committees, as needed
Consults with various business unit leaders throughout Point32Health in order to obtain necessary evidence, cooperation, or clarification
Other projects and duties as assigned.
Clinical License, Certified Fraud Examiner ("CFE") or Certified Professional Coder ("CPC") designation a plus
Degree in a clinical or scientific field, business, computer science, or criminal justice.
Preferred: Degree in a clinical or scientific field, business, computer science, or criminal justice.

Excellent writing and analytical skills. Excellent investigative skills
Total accuracy and attention to detail. Sound judgment and decision-making skills.

$105,477.36 -$158,216.04
Compensation & Total Rewards Overview
The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization.
The actual salary for this position will be determined by several factors, including the scope and complexity of the role
As part of our comprehensive total rewards program, colleagues are also eligible for variable pay.
Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare.
Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone.
We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are.
5-7 years related experience in health insurance fraud investigations with at least two years in a senior investigative capacity.

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background
it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.
Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions.
We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
Learn more about who we are at Point32Health.

This listing is sourced directly from Point32Health's careers page and normalized into a canonical job model.