VirtualVocations
Key Responsibilities
Lead and support an enterprise-wide team to detect, investigate, and mitigate fraud, waste, and abuse (FWA) across all business lines
Develop and execute a forward-looking FWA investigation strategy aligned with regulatory obligations and business priorities
Oversee the intake, triage, investigation, and resolution of suspected FWA cases while ensuring compliance with federal and state mandates
Required Qualifications, Training, and Education Bachelor's degree in business administration, Healthcare Administration, Law, or related field required; Master's degree or Juris Doctor preferred
10+ years of progressive experience in fraud investigations, healthcare compliance, or regulatory enforcement required
Significant experience managing large-scale FWA programs in a health plan, payer, government agency, or consulting firm required
Deep knowledge of federal and state health programs and FWA regulatory frameworks required
Proven leadership experience with cross-functional teams and external regulators required
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Develop and execute a forward-looking FWA investigation strategy aligned with regulatory obligations and business priorities
Oversee the intake, triage, investigation, and resolution of suspected FWA cases while ensuring compliance with federal and state mandates
Required Qualifications, Training, and Education Bachelor's degree in business administration, Healthcare Administration, Law, or related field required; Master's degree or Juris Doctor preferred
10+ years of progressive experience in fraud investigations, healthcare compliance, or regulatory enforcement required
Significant experience managing large-scale FWA programs in a health plan, payer, government agency, or consulting firm required
Deep knowledge of federal and state health programs and FWA regulatory frameworks required
Proven leadership experience with cross-functional teams and external regulators required
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