Manager, Special Investigation Unit (SIU)

Location: Remote - Florida, United States

Salary: $87,700–$157,800 per year

Company

hirify.global provides healthcare services focused on connecting people with the care they need.

What you will do

• Develop, implement, and manage strategic fraud, waste, and abuse activities.
• Monitor business processes and systems for integrity and compliance in billing and claims payment.
• Lead investigations of potential fraud, waste, and abuse referrals.
• Develop educational materials to identify and address waste activities.
• Review post-payment cases and coordinate refund recovery.
• Prepare monthly and quarterly savings reports and participate in committees and interdepartmental meetings.

Requirements

• Bachelor’s degree in business, healthcare, criminal justice, a related field, or equivalent experience.
• 4+ years of combined experience in medical claims investigation, financial impact analysis, business analysis, compliance, or fraud and abuse.
• Thorough knowledge of medical terminology.
• Experience in a managed care environment and leading or supervising staff is preferred.
• Knowledge of Microsoft Excel, medical coding, claims processing, and data mining is preferred.
• Medical records or coding license is preferred.

Culture & Benefits

• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Flexible work approaches, including remote, hybrid, field, and office schedules.
• Equal opportunity workplace committed to diversity and inclusion.