Jobs and Careers
HM
Manager, Special Investigations Unit
HMSAUnited Statesfull_timeVerifiedPosted 18 Feb 2026
About the role
- Program Oversight/Leadership for FWA SIU:
- Provide strategic oversight of the FWA SIU program
- Ensure compliance with all applicable FWA regulatory requirements
- Maintain independence and objectivity of SIU investigations
- Oversee intake, prioritization, and outcomes of investigations
- Review and approve investigative findings and referrals
- Escalate significant FWA risks to executive leadership
- Oversee vendor and delegated FWA/SIU activities
- Monitor FWA trends, metrics, and program effectiveness
- Oversee FWA related reporting
- Support audit readiness and regulatory inquiries
- Cross-Functional Team Partnerships:
- Partner with Compliance to ensure regulatory alignment and audit readiness
- Collaborate with Medical Management on utilization and clinical FWA risks
- Coordinate with Provider Relations on provider actions and remediation
- Work with Finance on recoveries, overpayments, and financial reporting
- Coordinate with Legal as appropriate on investigations, and enforcement actions
- Support Operations with FWA education, guidance, and risk mitigation
- Coordinate with delegated entities and vendors on FWA oversight and reporting
- Serve as the primary SIU liaison to internal and external stakeholders
- Leadership:
- Selects, trains, develops and organizes staff.
- Monitors overall inventory of work and prioritizes the staff's work to meet performance standards and authorizes additional resources as needed.
- Provides feedback and coaching (helping individuals to solve problems/issues on their own) including timely completion of any interim and year-end performance reviews.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
- Bachelor's degree and five years of related work experience; or equivalent combination of education and work experience.
- Three years of supervisory or management experience.
- Effective verbal and written communication skills.
- Collaborative crisis management skills.
- Ability to develop programs based on relevant industry best practice and regulations.
- Interpretation of government regulations and applicable codes to ensure compliance.
- Basic working knowledge of Microsoft Office application, including word, excel, powerpoint, outlook.
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