Director of Fraud Waste & Abuse – Special Investigations Unit

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🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $122k - $177k / year

⏰ Full Time

🔴 Lead

👔 Director

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Boston Medical Center (BMC)

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5001 - 10000 employees

Founded 1996

Boston Medical Center (BMC) is a 511-bed, equity-led academic medical center and a proud member of the Boston Medical Center Health System. BMC delivers a model of healthcare where innovative and equitable care empowers all patients to thrive. As a premier academic medical center in Boston, a national leader in clinical care, and the largest essential hospital in New England, BMC’s world-class clinicians provide comprehensive care in more than 70 specialties and subspecialties.

📋 Description

• Leads the enterprise-wide FWA program across Medicare, Medicaid, commercial, and delegated vendor lines of business • Operates with a high degree of autonomy and strategic authority • Drives the design and execution of multi-year program strategy • Advances fraud detection and predictive analytics capabilities • Ensures organizational compliance with applicable federal, state, and contractual regulatory requirements • Delivers measurable impact on organizational revenue protection, program integrity, and risk reduction

🎯 Requirements

• Bachelor’s degree in criminal justice, business administration, healthcare management, or a related field • At least 10 years of experience in healthcare fraud investigations, compliance, payment integrity, or related field • At least 5 years must be leadership experience managing FWA SIU programs and teams in a multistate health plan with diversified product portfolio • Certified Fraud Examiner (CFE) • Accredited Healthcare Fraud Investigator (AHFI) • Certified Professional Coder (CPC) • Certified Financial Crimes Investigator (CFCI) or similar certification • Knowledge of Medicare, Medicaid, and commercial health plan operations • Ability to analyze and interpret complex datasets to identify fraud patterns • Skill in developing and implementing fraud detection frameworks

🏖️ Benefits

• medical • dental • vision • pharmacy • discretionary annual bonuses • merit increases • Flexible Spending Accounts • 403(b) savings matches • paid time off • career advancement opportunities • resources to support employee and family well-being