Fraud, Waste, and Abuse Manager

Summary

The Fraud, Waste, and Abuse (FWA) Manager is responsible for developing, implementing, and managing programs and processes to prevent, detect, and respond to fraud, waste, and abuse within the organization. This role involves conducting thorough investigations, analyzing data to identify potential risks, and collaborating with various departments to foster a culture of compliance and integrity. The FWA Manager will also ensure adherence to all relevant laws, regulations, and internal policies.

Duties & Responsibilities

• Program Development and Management:
• Develop and implement comprehensive FWA prevention, detection, and response programs
• Establish and maintain policies and procedures to mitigate FWA risks
• Conduct regular reviews and updates of FWA policies to ensure compliance with legal and regulatory changes
• Investigation and Analysis:
• Lead and conduct thorough investigations into allegations of fraud, waste, and abuse
• Analyze data and trends to identify potential FWA risks and vulnerabilities
• Prepare detailed investigation reports with findings, conclusions, and recommendations for corrective actions
• Collaboration and Training:
• Work closely with internal departments (e.g., Finance, Legal, HR) to address FWA issues and implement preventive measures
• Develop and deliver training programs to educate employees on FWA awareness and prevention
• Act as a subject matter expert on FWA matters, providing guidance and support to staff and management
• Monitoring and Reporting:
• Monitor and review transactions, activities, and processes to detect potential FWA incidents
• Maintain an accurate and up-to-date log of all FWA cases and investigations
• Prepare and present regular reports on FWA activities, trends, and outcomes to senior management and relevant stakeholders
• Regulatory Compliance:
• Ensure the organization's FWA programs comply with all applicable laws, regulations, and industry standards
• Stay current on legal and regulatory developments related to FWA and incorporate best practices into the organization's policies and procedures
• Lead a team of Fraud, Waste and Abuse Analysts
• Other duties as assigned by management.
• REQUIREMENTS & QUALIFICATIONS
• Education: Associate degree in Health Administration, Business Administration, or related field preferred
• Experience: Minimum of 5 years of experience in fraud investigation, risk management, compliance, or a related field
• Proven track record of managing FWA programs and conducting complex investigations
  
  

Job Type: Full-time

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