Fraud & Provider Recovery Manager

Highmark; Pittsburgh (Allegheny County); On-site; USD 85,000 - 120,000; Full time

Job summary

Highmark in Pittsburgh is seeking a leader for their Financial Investigations & Provider Review department. The role involves managing fraud detection initiatives, guiding staff in investigations, and developing recovery strategies for overpayments.

The ideal candidate will have a Bachelor’s degree, significant auditing experience, and strong leadership skills. The position emphasizes collaboration with various departments and adherence to regulatory requirements.

Qualifications

• 6 years’ minimum experience in auditing, consulting and/or fraud investigations.
• 5 years’ experience auditing and leading provider audits.
• 3 years’ managerial/supervisory experience.

Responsibilities

• Manage day-to-day activities of the Financial Investigations department.
• Provide guidance to team leads and staff on investigation strategies.
• Develop action plans for financial recovery opportunities.

Skills

Strong verbal and written communication skills

Leadership skills

Organizational skills

Analytical skills

Knowledge of hospital reimbursement strategies

Education

Bachelor’s Degree – Business, Finance, Healthcare Administration

Business Administration (Preferred)

Job description

Highmark in Pittsburgh is seeking a leader for their Financial Investigations & Provider Review department. The role involves managing fraud detection initiatives, guiding staff in investigations, and developing recovery strategies for overpayments.

The ideal candidate will have a Bachelor’s degree, significant auditing experience, and strong leadership skills. The position emphasizes collaboration with various departments and adherence to regulatory requirements.