Fraud Senior Advisor - Special Investigations Unit (SIU) Matter Resolution

Fraud Senior Advisor - Special Investigations Unit (SIU) Matter Resolution

Our organization is a leader in healthcare services, committed to integrity, innovation, and excellence.

We strive to protect our members and partners through robust compliance and fraud prevention programs, fostering a culture of accountability and collaboration.

Position Overview

The Fraud Senior Advisor - Special Investigations Unit (SIU) Matter Resolution plays a critical role in negotiating settlements, advising investigative teams, and ensuring compliance with legal and regulatory standards.

This position develops strategies to resolve disputes, recover overpayments, and minimize legal exposure while collaborating with internal and external stakeholders.

Key Responsibilities


* Provide guidance to SIU investigative teams to ensure consistent handling of investigations and proper evidence collection.


* Develop and execute strategies to resolve disputes with providers, recover overpayments, and minimize legal exposure.


* Negotiate settlements and corrective action plans with support from investigators, Medical Directors, and subject matter experts.


* Collaborate with Legal on litigation matters and special projects, maintaining awareness of legal principles impacting SIU operations.


* Support relationships with law enforcement, prosecutorial authorities, and departments of labor to enhance matter resolution and recovery efforts.


* Work with Legal, Compliance, Provider Contracting, Public Affairs, and Sales to provide customer-centric messaging on complex matters.


* Maintain active participation in industry and trade associations, including the National Healthcare Anti-Fraud Association (NHCAA).

Qualifications


* Law degree required.


* 5+ years' experience resolving legal disputes through settlement or litigation.


* Strong analytical and communication skills.


* Ability to manage a large volume of matters and perform at a high level in a dynamic team environment.

Core Competencies


* Negotiation and Conflict Resolution: Skilled in achieving favorable outcomes in complex disputes.


* Legal Acumen: Deep understanding of legal principles and regulatory requirements.


* Collaboration: Builds strong relationships across internal and external stakeholders.


* Strategic Thinking: Anticipates challenges and develops proactive solutions.


* Communication: Delivers clear, concise, and persuasive messaging.

Candidates who reside within 50 miles of Bloomfield, CT may be asked to work a hybrid, in office/work from home, flexible arrangement.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 104,900 - 174,800 USD / yearly, depending on relevant factors, including experien...