Job Overview
Location
Remote
Job Type
Full-time
Category
HR & Recruiting
Date Posted
July 10, 2026
Full Job Description
đź“‹ Description
- • Drive and encourage innovative investigative processes and workflows to reduce turnaround time and produce positive investigative outcomes.
- • 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.
🎯 Requirements
- • Bachelor's degree in Health-Related Field, Law Enforcement, or Insurance required.
- • 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.
- • Intermediate proficiency in Microsoft Outlook, Word, Excel, Access, and Power Point.
- • One of the following certifications is required: Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE).
🏖️ Benefits
- • Bonus tied to company and individual performance.
- • Comprehensive total rewards package.
Skills & Technologies
See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.
About CareSource Management Group Company
CareSource is a nonprofit, multi-state managed care organization headquartered in Dayton, Ohio. Founded in 1989, it administers Medicaid, Medicare Advantage, and Marketplace health plans serving over two million members in Ohio, Kentucky, Indiana, West Virginia, and Georgia. The company focuses on improving health outcomes for low-income and vulnerable populations through integrated care management, behavioral health services, and social determinants programs.
Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.
Newsletter
Weekly remote jobs and featured talent.
No spam. Only curated remote roles and product updates. You can unsubscribe anytime.
Similar Opportunities
Lemlist SAS
2 months ago
3 months ago
Arlo Technologies, Inc.
3 months ago
3 months ago