Director of Fraud Prevention & Program Integrity

University Health; San Antonio (TX); On-site; USD 150,000 - 210,000; Full time

Job summary

Community First Health Plans, Inc. in Texas seeks a Director, Fraud Prevention and Program Oversight to lead anti-fraud efforts across Medicaid, CHIP, Medicare, Marketplace and Commercial lines.

You will set enterprise standards, strengthen internal controls, and oversee SIU operations, payment integrity analytics, and vendor oversight. The role requires a Bachelor’s degree in accounting or related field, with at least three years of audit and supervisory experience; experience with SOX/NAIC MAR

Qualifications

• Bachelor's degree in accounting, business administration or related field.
• Experience with anti-fraud detection and prevention is required.
• Three years of supervisory experience is preferred.
• Experience with SEC SOX and NAIC MAR audits, and ERM is highly desirable.
• At least three years of professional audit experience is required.

Responsibilities

• Lead the organization’s fraud prevention, detection, investigation, and remediation efforts across all product lines.
• Set enterprise standards, strengthen internal controls, and oversee SIU operations, payment integrity analytics and vendor oversight.
• Oversee internal auditing functions to ensure program integrity and regulatory compliance.

Skills

Audit experience

SOX & NAIC MAR audits

Regulatory interpretation

Supervisory experience

Enterprise Risk Management (ERM)

Education

Bachelor's degree in accounting, business administration or related field

Job description

Community First Health Plans, Inc. in Texas seeks a Director, Fraud Prevention and Program Oversight to lead anti-fraud efforts across Medicaid, CHIP, Medicare, Marketplace and Commercial lines.

You will set enterprise standards, strengthen internal controls, and oversee SIU operations, payment integrity analytics, and vendor oversight. The role requires a Bachelor’s degree in accounting or related field, with at least three years of audit and supervisory experience; experience with SOX/NAIC MAR