Manager, Special Investigation Unit (ATL)

The Intersect Group

Los Angeles, CA(remote)

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JOB DETAILS

SALARY

$58–$63 Per Hour

SKILLS

Adjudication, Analysis Skills, Automation, C++ Active Template Libraries (ATL), Claims Processing, Coaching, Communication Skills, Criminal Justice, Cross-Functional, Customer Escalations, Forecasting, Fraud Investigation, Health Insurance, Healthcare, Law Enforcement, Leadership, Legal, Maintain Compliance, Metrics, Microsoft Excel, Microsoft PowerPoint, Microsoft SharePoint, Microsoft Visio, Microsoft Word, Multilingual, Multiplatform/Cross-Platform, Multitasking, Operational Improvement, Operational Strategy, Operations Management, Performance Analysis, Performance Management, Performance Metrics, Process Improvement, Project/Program Management, Quality Management, Recruiting Strategy, Regulatory Compliance, Risk Analysis, Strategic Planning, Team Building, Team Lead/Manager, Time Management, Trend Analysis

LOCATION

Los Angeles, CA

POSTED

10 days ago

Manager, Fraud Investigations and Compliance
Remote position - West Coast Time Zone
Pay Rate: $58-$63 per hour
Contract - 3-4 months

Company Overview
The Intersect Group partners with organizations dedicated to improving access, quality, and outcomes in complex service environments. Our client operates one of the largest publicly supported healthcare programs in the country, focused on delivering high quality care to diverse and underserved communities. Their mission driven culture emphasizes accountability, inclusion, and measurable impact across millions of members.

Role Summary
The Manager of the Special Investigation Unit leads investigative operations focused on identifying and mitigating fraud, waste, and abuse across multiple lines of business. This role drives strategic initiatives, oversees investigative staff, and partners with compliance, legal, and external agencies to ensure integrity in claims processing.

You will manage day to day SIU operations, guide high impact investigations, and implement process improvements that enhance detection, recovery, and reporting outcomes. This position plays a critical role in protecting organizational resources, improving operational efficiency, and ensuring regulatory compliance.

Key Responsibilities
Lead and develop a team of investigators, managing performance, coaching, hiring, and day to day operations
Oversee fraud investigations across multiple claim platforms, ensuring accuracy, compliance, and timely resolution
Track and report key performance indicators including recoveries, savings, and investigative outcomes
Partner with legal, compliance, regulators, and law enforcement on escalated cases and formal investigations
Drive process improvement and automation initiatives to enhance efficiency and detection capabilities
Develop and document workflows, policies, and procedures to strengthen investigative operations
Collaborate with analytics teams to identify trends, risks, and new investigation opportunities
Support forecasting, staffing strategy, and operational planning to meet business demands

Key Requirements
Minimum 5 years of fraud investigation experience with at least 3 years in a leadership or management role
Strong knowledge of fraud, waste, and abuse within healthcare or insurance environments preferred
Experience managing multiple projects and leading initiatives to successful completion
Proficiency in Microsoft Excel, Word, PowerPoint, and SharePoint with working knowledge of Visio
Ability to analyze metrics, identify trends, and translate data into actionable insights
Bachelors degree in Criminal Justice, Law, or related field or equivalent experience
Strong communication skills with the ability to work cross functionally and present to stakeholders
Proven leadership skills with a focus on team development, accountability, and performance management

Preferred Qualifications
Experience in healthcare claims adjudication
Prior leadership experience managing investigative teams
Bilingual proficiency in one or more commonly spoken languages in diverse communities

Call to Action
If you are a results driven investigative leader looking to make a meaningful impact, we encourage you to apply today. Please submit your resume along with your contact information to be considered.

About the Company

The Intersect Group

The Intersect Group is a different and better business partner. We create unparalleled value for our clients by combining industry-leading Consulting capabilities with comprehensive Staffing and recruitment services. Clients trust us to deliver results based on our deep expertise and proven resources within finance, accounting, and information technology. Through our flexible delivery approach, you get the right solution, at the right time to accelerate your success and achieve all of your mission-critical objectives.

COMPANY SIZE

500 to 999 employees

INDUSTRY

Staffing/Employment Agencies

FOUNDED

2006