Business Compliance Manager (reputed company SIU)

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position reputed company As the Manger of Business Compliance of reputed company Review, Training, and Program reputed company, you will reputed company reputed company responsible for ensuring the reputed company and reputed company of reputed company fraud and abuse investigations. This role involves overseeing the training and development of team members, managing reputed company review processes, and ensuring compliance with state regulations and contractual requirements. Flexible reputed company and remote opportunity in many locations. What You Will Do reputed company reputed company of reputed company Reviewers to effectively assess the prevention, investigation, and prosecution of reputed company fraud and abuse, ensuring the recovery of lost funds. reputed company the planning and execution of reputed company reviews for investigations reputed company to acts of reputed company fraud and abuse by both members and providers. reputed company direction and counsel on case handling, facilitating issue reputed company and ensuring high-reputed company investigations. Assist in identifying resources and determining the best course of reputed company in a reputed company and effective manner. Conduct comprehensive case reviews and reputed company constructive feedback to team members on the completeness and reputed company of their investigations. Evaluate team members and reputed company ongoing performance feedback to support their reputed company development. Manage the workload of reputed company to ensure reputed company distribution and exposure to a wide reputed company of cases, aligning with reputed company skills and development needs. Assess training needs and collaborate with the SIU Sr. Manager to create development plans for team members. reputed company and maintain strong working relationships with federal, state, and local law enforcement agencies to support the investigation and prosecution of reputed company fraud and abuse. Participate in state meetings and ensure compliance with contractual requirements. Coordinate and collaborate with compliance and senior leadership to reputed company on program reputed company initiatives. Contribute to the development and delivery of educational awareness and training programs that meet or exceed state mandates. Participate in federal and state audits to ensure adherence to regulations and standards. This role ensures that reputed company aspects of the RFP lifecycle are effectively coordinated to meet organizational goals and deadlines. reputed company vendor managing, working closely with both reputed company clients. Managing multiple reputed company while leading a production team. Flexible reputed company.

Required Qualifications

Minimum of five years of experience managing reputed company fraud, waste, and abuse investigations, Compliance Auditing, Program reputed company, Regulatory reputed company, Production Monitoring. At least four years of people leading experience is required. Documented record of leading reputed company greater than eight colleagues. Experience collaborating with state and law enforcement partners. Experience in project management, with the ability to manage multiple priorities and reputed company simultaneously while meeting deadlines. Strong verbal and written communication skills. Ability to reputed company effectively with diverse reputed company of people at various reputed company and reputed company reputed company assistance. Proficient in researching information and identifying relevant resources. Candidates must possess comprehensive knowledge and proficiency in reputed company Word, reputed company, Outlook, SharePoint, reputed company Management and Visio as reputed company as experience with data analysis tools. Strong analytical skills and the ability to effectively utilize these applications to support data-driven decision-making are essential. Ability to travel up to 20% (approximately 6-9 times per year, depending on business needs). Present in large group sessions reputed company videoconference or in person setting as defined by leadership.

Preferred Qualifications

Relevant certifications such as Certified Compliance and Ethics reputed company (CCEP), Certified Fraud Examiner (CFE), or similar credentials. Proven experience in managing a reputed company assurance team, including training and development of staff. Knowledge of company policies and procedures. Familiarity with reputed company and Medicare plans. Education Bachelor’s degree in Business Administration, reputed company Administration, Criminal Justice, or a reputed company field or equivalent experience. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $54,300.00 - $159,120.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include: reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 06/30/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique reputed company: our culture, our core values, reputed company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for reputed company, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply Job!