Health Care Service Corporation

Director of Special Investigations

Health Care Service Corporation$121K — $225K *
Healthcare
8 - 10 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's Degree required.
  • 10 years of experience in law enforcement or complex healthcare fraud investigations.
  • 4 years of managerial experience necessary.
  • Strong administrative and organizational skills.
  • Excellent verbal, written, and interpersonal communication.
  • Proven ability to build and maintain effective liaison relationships.
  • Skilled in translating needs into compelling business cases and conducting cost-benefit analyses.

Responsibilities

  • Lead the Special Investigations Department across Texas, Oklahoma, and New Mexico.
  • Direct healthcare fraud investigations and manage the Enterprise-Wide Intelligence Unit.
  • Serve as the primary liaison with law enforcement agencies, including the FBI and HHS.
  • Collaborate with other departments on civil and criminal matters related to investigations.
  • Oversee audit and compliance activities pertaining to SID operations.
  • Manage the development and oversight of the SID budget and related financial activities.

Benefits

  • Comprehensive health and wellness benefits.
  • 401(k) savings plan and pension plan options.
  • Generous paid time off and parental leave.
  • Disability and supplemental life insurance.
  • Employee assistance program and paid holidays.
  • Tuition reimbursement for continued education and career development.
Full Job Description
Job Summary


The Director of Special Investigations will lead the Special Investigations Department (SID) in Texas, Oklahoma, and New Mexico. In addition to directing all healthcare fraud investigations within these states, this position will oversee SID's Enterprise-Wide Intelligence Unit, which is primarily responsible for identifying healthcare fraud schemes.

SID's primary mission is to seek the criminal prosecution of individuals and entities that defraud HCSC and its customers. This position will serve as the primary liaison with the FBI, the U.S. Department of Health and Human Services (HHS), and other law enforcement agencies. The Director will also partner with other HCSC departments, including Legal, Medical, and Network, on civil and criminal matters related to SID investigations.

Additionally, this position will be responsible for audit and compliance activities related to SID operations. The Director will oversee the development and management of the SID budget and related financial activities for Texas, Oklahoma, and New Mexico.

JOB REQUIREMENTS:

  • Bachelor Degree.
  • 10 years experience in law enforcement or conducting complex health care fraud or white collar fraud investigations.
  • 4 years of managerial experience.
  • Administrative and organizational skills.
  • Clear and concise verbal, written, and interpersonal communication.
  • Experience developing and maintaining effective liaison relationships.
  • Translating needs and initiatives into compelling business cases.
  • Conducting cost-benefit analyses to justify investments and ensure ROI.


PFREFERRED JOB REQUIREMENTS:

  • Experience in the administration of government programs.
  • Management and administration of health care fraud investigations.
  • Master’s Degree

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!


Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

Base Pay Range
$121,200.00 - $225,200.00

Exact compensation may vary based on skills, experience, and location.

About Health Care Service Corporation

Health Care Service Corporation (HCSC) is the largest customer-owned health insurer in the United States. HCSC offers a wide variety of health insurance products and related services, through its operating divisions and subsidiaries in Illinois, Montana, New Mexico, Oklahoma and Texas. HCSC's headquarters is located in Chicago, Illinois.
Learn more about Health Care Service Corporation
Size
24,000 employees
Industry
Founded
1936

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