Pride Health is hiring a Mgr Special Investigations to support our client’s medical facility based in Texas.

This is a 3-month contract with the possibility of an extension, competitive pay and benefits, and a great way to start working with a top-tier healthcare organization

Title: Mgr Special Investigations

Duration: 3 Months + Possible Extension

Location: Bellaire, Texas 77401 (Hybrid)

Shift: 8:00 AM - 4:00 AM

Pay Range: $45hr. - $50/hr.

Work Experience

• Coordinates with subcontractors on overseeing investigations of Fraud, Waste & Abuse (FWA).
• Manages a large fraud investigation caseload and investigates allegations relating to potential health care fraud perpetrated by Medicaid and commercial providers, vendors and enrollees.
• Provides internal and external case updates on progression of investigations in coordination with SIU team members and other departments, including recommendations on further action and/or resolution, as needed.
• Continually interfaces with members, vendors, pharmacies, providers and other third parties via telephone, e-mail, and on-site visits as needed to identify, further, and conclude ongoing investigations.

Skills

• Required- H.S. Diploma or GED OR Bachelor's Degree
• Required- 8 years- experience in fraud, waste & abuse (FWA) investigations or special investigations unit (SIU) including 1 yr experience working with Medicaid.
• One of the below certifications are Required-
• CPA - Cert-Cert Public Accountant- Relevant state board of public accountancy
• CFA - Certified Fraud Examiner- Association of Certified Fraud Examiners
• AHFI - Accredited Health Care Fraud Investigator - NHCAA National Health Care Anti Fraud Association
• INT-POPC Intermediate Peace Officer Proficiency Certificate- Intermediate Peace Officer Proficiency Certificate.

As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.

Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.