The Director of Compliance Investigations is responsible for leading the investigations team, managing allegations of Compliance policy violations, and ensuring all necessary corrective actions are taken to maintain an effective Compliance program. This role requires a forward-thinking leader who can drive process improvements and leverage technology to support compliance activities.

This role may work remotely but near site in New York, New Jersey or Pennsylvania.

National base range $160,000 - $180,000 but actual compensation dependent on location + 20% AIP.

Salary offers are based on a wide range of factors including relevant skills, training, experience, education, and, whereapplicable, certifications obtained. Market and organizational factors are also considered. Successful candidates may be eligible to receive annual performance bonus compensation.

JOB RESPONSIBILITIES

• Lead and manage the investigations team (supervising 2+ investigators), delegating tasks and driving timely decision-making.
• Oversee the entire investigations process, from managing the employee hotline and vendor relationships to ensuring all allegations of Compliance policy violations are thoroughly addressed andnecessary corrective actions are taken to help ensure an effective and consistent Compliance program
• Develop and implement strategic, enterprise-wide resolutions to address systemic issues and mitigate risk.
• Utilize reporting and analytics to identify trends, present findings to senior leadershipin a cohesive and succinct manner and proposeproactive actions to prevent compliance issues.
• Collaborate with Regional Compliance Directors, Compliance Managers, HR analysts, and other cross-functional teams to ensure a consistent and effective corrective action process.
• Partner with business units to foster a customer-focused approach while upholding the integrity of the investigation process.
• Prepare and present high-quality reports and cohesive summaries on investigation trends, root causes, and analyses to senior leadership.
• Work with cross-functional teams to implement and support the Navex database and hotline technology tool.
• Maintain composure and confidence when managing against pressure and adversity.

This role assists in safeguarding the companys financial stability and reputation by mitigating risks that could lead to revenue loss. This is achieved by:

• Strategic Decision Making: The ability to convey information to senior leadership and to write reports in concise manners to convey trends and analysis ensures that leadership is well-informed to make strategic decisions that protect the company from financial liabilities and support sustained revenue generation
• Proactive Risk Management: Utilizing reporting and analytics to trend data, present findings and propose proactive actions which allows the company to address systemic issues before they escalate into major problems that could result in significant financial loss or operational disruption
• Ensuring Business Continuity:By partnering with the business to collaborate and be customer focused, the investigative process aims to resolve issues efficiently while minimizing disruption to core business functions and customer relationships, thereby helping to retain revenue streams

The role is inherently leadership-focused, guiding teams and strategic initiatives. Key leadership tasks include:

• Transform investigations process using process improvement tools and curiosity
• Implement strategic thinking for enterprise resolutions
• Present at compliance leadership meetings, department meetings and functional meetings
• Be strategic and resourceful when gathering information, knowing the right questions to ask in difficult situations ensuring full understanding of the issue
• Partner with the business to collaborate and be customer focused while upholding the integrity of the investigation process

Required WorkExperience:

• 10+ years of Fraud and Abuse Laws and a background in compliance

Preferred Work Experience:

• Prefer five to ten years in the Healthcare industry as a leader with knowledge of the Fraud and Abuse Laws and a background in compliance, billing, medical technology.

Physical and Mental Requirements:

• Working knowledge of the Fraud and Abuse Laws, compliance policies, and laboratory practices and the impact of potential violations.

Technical /Job Specific Knowledge:

• Experience conducting investigations and project management.
• In-depth working knowledge of Fraud and Abuse Laws, compliance policies.
• Utilize technology to improve efficiencies in processes

Skills:

• Proficiency in Outlook, Word/Access/Excel, use of AI, Ability to work effectively both independently and within a team.
• Interview and use strategic thinking skills, including the ability to discern critical from non-critical facts
• Analyze and identify potential compliance concerns
• Leverage effective negotiation skills using active listening and empathy, with the ability to stand firm on a decision often with employees at a senior level
• Utilize reporting and analytics to trend data, present findings and propose proactive actions
• Develop and implement action plans based on limited information
• Write high quality reports with concise summaries to convey trends and where relevant, root causes, and analysis
• Analyze and communicate facts obtained through the investigative process as necessary within all levels of the organization

People Leader Responsibility:

• Supervises 2+ investigators

Travel required

Education:

• Bachelors Degree (Required)
• Working knowledge of the Fraud and Abuse Laws, compliance policies, and the impact of potential violations. (Preferred)