Senior Manager, Healthcare Fraud – Program Integrity

Vaga não está no LinkedIn

🕒 Outubro 27

🤠 Texas – Remoto

🤠 Texas – Remote

💵 $109.000 - $155.700 / ano

⏰ Tempo Integral

🟠 Sênior

👔 Gerente

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Gainwell Technologies

SiteLinkedInTodas as Vagas

10.000+ funcionários

💼 Consultoria

📦 Logística

⚕️ Seguro de Saúde

💰 Grant em 2023-06

Consulting • Logistics • Healthcare Insurance

A Gainwell Technologies é a principal provedora do país de soluções digitais e cloud-enabled em todo o ecossistema de serviços humanos e saúde pública. Com uma abordagem orientada por propósito, a Gainwell atende clientes nos 50 estados dos EUA, com foco em melhorar os desfechos em saúde e oferecer experiências intuitivas e centradas nas pessoas. Seu portfólio abrangente inclui modernização do Medicaid Enterprise, data analytics, serviços para prestadores e soluções para farmácia — tudo projetado para impulsionar o futuro da saúde e promover o bem-estar das comunidades.

Descrição

• Serve as the primary client advocate and support leader for FraudCapture • Lead client support, training, onboarding, and enablement activities • Manage client-facing sessions, including new-client training, implementation workshops, hyper-care meetings, and recurring office hours • Establish and deliver investigator, analyst, and supervisor training curricula • Manage client user account setup and administration, including onboarding, offboarding, role-based access, role changes, and access maintenance • Create and manage client communications for outages, fixes, feature launches, and policy updates • Provide escalation support for complex user questions, system configuration issues, and workflow troubleshooting • Own user defect intake, triage, end-to-end defect management, SLAs, client communications, resolution tracking, and trend reporting • Monitor product adoption, training effectiveness, and support trends and recommend improvements • Manage training content, videos, job aids, quick starts, release notes, and What’s New content • Manage, coach, and scale customer support staff, including hiring, onboarding, scheduling, and performance management • Establish and improve support processes and SLAs, including response times, resolution targets, escalation procedures, ticket quality, and customer satisfaction metrics • Support CMS certification and reporting requirements • Collaborate with Product Management, Engineering, QA, Account Management, Sales, Customer Success, Medicaid agencies, managed care organizations, and program integrity teams • Support demos, proof points, RFP responses, UAT, hyper-care, defect reproduction, fix monitoring, and deployments • Travel approximately 10–25% for client implementations, training events, conferences, and strategic meetings

🎯 Requisitos

• Bachelor's degree or equivalent combination of education and experience • 5+ years of direct healthcare fraud and abuse investigation experience • Strong understanding of healthcare fraud, waste, and abuse detection analytics and case management systems • Leadership experience in customer support, customer success, or services for SaaS software solutions • Proven success designing and delivering training programs and managing client interactions • Strong experience with defect management and communication across technical and non-technical stakeholders • Strong business and analytical problem-solving skills • Excellent written and verbal communication skills • Ability to multi-task and work independently • Ability to establish priorities and objectives for operations with limited direction • Investigative credentials such as CFE or AHFI and prior PI/MFCU/SIU leadership experience • Experience supporting or managing certified coders is a plus

🏖️ Benefícios

• Work flexibility • Learning and career development • Technical credentials and certifications • Generous, flexible vacation policy • Educational assistance • Leadership and technical development academies • 401(k) employer match • Comprehensive health benefits • Travel expense reimbursement may be included among benefits

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