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Deloitte Program Integrity – Healthcare Investigations Manager in San Francisco, California

Forensics Analytics Manager Program Integrity

Are you an analytical, data-driven professional? Are you interested in a role that uses leading edge analytics and offers an opportunity to provide front line support to solve our clients most challenging problems? If so, the Forensic Analytics practice within Deloitte Transactions and Business Analytics LLP (DTBA) is the place for you!

Forensic Analytics is a fast-growth practice within Deloitte Risk and Financial Advisory that centers around several of the hottest areas of business today analytics, forensic analysis, and litigation support and the specialized skills that make careers in these areas both fascinating and in high-demand. Our Analytics team makes extensive use of data, statistical and quantitative analysis, rules-based methods, and explanatory and predictive modeling to bring insights to client issues in the forensic and transaction domains. We work with specialists in many areas, and we apply our solutions to a wide range of highly interesting and complex corporate challenges, such as forensic investigations, sales fraud, anti-corruption compliance, restructuring, safety and quality, enterprise fraud and misuse management to explain what has occurred in the past and to support informed decision making for the future. Our work increasingly employs specialized competencies, such as advanced analytics, visualization, and geospatial techniques.

Work you ll do

Provide domain experience in Fraud, Waste and Abuse (FWA) Investigations

Guide the development and review of new FWA rules

Maintain a deep, working understanding of CPT, HCPCS, and ADA dental procedures codes and standard claim processing policies as defined by our clients

Managing our investigations team identifying potential fraud, waste, abuse, or improper payment.

Performing and interpreting medical, pharmacy and dental billing patterns to identify potential fraud, waste, abuse, or improper payment.

Interpreting policies to validate proper payment was made.

Serve as a Subject Matter Expert , adding interpretive value to data presented or experienced insight into a functional process or issue

Preparing and presenting complex written and verbal materials (reports, findings and presentations)

Contributing to a strong client relationship through interactions with client personnel on investigation-related issues.

Supervise, lead, and train junior staff in the aforementioned activities and career counseling

Responsible for managing solutions, delegating resources, and helping to ensure quality assurance principles are met across projects and deliverables

Assuming responsibility for small components of engagements. May have greater role on small engagements.

Maintain technical knowledge within industry and service line and leverage deep subject matter knowledge on engagements

Contribute to new business proposals and client pursuits and lead proposal development

Manage own personal and professional development; seek opportunities for professional growth and expansion of consulting skills and experience

Network and negotiate to identify and sell potential new services or expand existing engagements by leveraging client relationships

Generate marketplace eminence through the creation of intellectual property across a host of mediums including but not limited to: articles, whitepapers, webcasts and other audio visual presentations

The Team

As the regulatory landscape continues to shift and grow in complexity, companies are facing unprecedented compliance challenges and close regulatory scrutiny. We provide solutions in health care compliance, risk and technology-driven managed services. Managing your financial, operational, and reputational risk to allow you to focus on what matters most - the patient, innovation, and the greater health care marketplace.

Qualifications

Bachelor's degree in Accounting, Business, Finance or other Business-related field

5 years of investigations experience

2 years in a technical or functional lead role

Experience mentoring and coaching others

Extensive knowledge of medical and dental procedure codes, claims processing, and provider relations, as well as the ability to understand the cascading impact of claims processing policy changes on key performance indicators, claim costs, and overall financial health of the organization

Proven leadership skills demonstrating strong judgment, problem-solving, and decision-making abilities

Experience managing senior-level client relationships

Experience presenting to clients or other decision makers to present and sell ideas to various audiences (technical and non-technical)

Pre-sales, proposal, and RFP experience

Must be able to obtain and maintain required clearance for this role

Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.

Preferred

Experience reviewing dental claims, charts, and x-rays

Experience reviewing and interpreting dental policy

Previous experience as a dental adjudicator

Accredited Healthcare Fraud Investigator (AHFI)

Certified Professional Coder (CFE)

Certified Fraud Examiner (CFE)

Benefits

At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. Learn more about what working at Deloitte can mean for you at http://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards.html .

Deloitte s culture

Our positive and supportive culture encourages our people to do their best work every day. We celebrate individuals by recognizing their uniqueness and offering them the flexibility to make daily choices that can help them to be healthy, centered, confident, and aware. We offer well-being programs and are continuously looking for new ways to maintain a culture where our people excel and lead healthy, happy lives. Learn more about Life at Deloitte .

Corporate citizenship

Deloitte is led by a purpose: to make an impact that matters. This purpose defines who we are and extends to relationships with our clients, our people and our communities. We believe that business has the power to inspire and transform. We focus on education, giving, skill-based volunteerism, and leadership to help drive positive social impact in our communities. Learn more about Deloitte s impact on the world. at http://www2.deloitte.com/us/en/pages/about-deloitte/articles/deloitte-corporate-citizenship.html

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Category: Finance

About Deloitte

As used in this document, Deloitte means Deloitte LLP and its subsidiaries. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.

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