FWA & Subrogation Program Manager

Universal Health Services; Reno (NV); On-site; USD 120,000 - 160,000; Full time

Benefits offered by this job

Loan forgiveness

Paid time off

Medical coverage

Dental coverage

Vision coverage

401(k) with company match

Student loan refinancing

Career development

Job summary

Prominence Health, part of Universal Health Services, is seeking a Manager of Fraud, Waste, Abuse to lead its FWA, Subrogation, and Payment Integrity programs. You will direct investigations, recoveries, and cost-containment initiatives while collaborating across departments and external partners to ensure compliance and accuracy.

The role emphasizes coordination of benefits, MSP efforts, and timely resolution of opportunities, with focus on data-driven decision-making and regulatory adherence.

Qualifications

• Bachelor’s Degree or equivalent in Health-Related Field or Insurance.
• 3–5 years in healthcare such as insurance, medical claims, or contracting.
• Experience in healthcare fraud investigations, auditing, data analytics.
• Ability to apply medical terminology to review claims for coverage decisions.
• Preferred: AHFI, CFE, CPC certifications.
• Ability to manage demanding investigative caseload.
• Strong written and verbal communication skills.
• Experience with MS Office and Smartsheet.
• Confidentiality and compliance with regulations.
• Experience in subrogation operations preferred.

Responsibilities

• Lead Prominence’s FWA, Subrogation, Third-Party Liability (TPL), and Payment Integrity programs.
• Provide strategic direction, oversight, and leadership for investigations and recoveries.
• Coordinate ESRD coordination of benefits and MSP initiatives.
• Collaborate across departments and external partners to ensure accuracy and compliance.
• Ensure policies and regulatory requirements are met with timely service delivery.

Skills

Healthcare investigations

Data analytics

Claims review

Regulatory compliance

Investigation workload management

Communication skills

Subrogation knowledge

MSP knowledge

QnXT familiarity

Smartsheet

Education

Bachelor’s Degree or equivalent in Health-Related Field or Insurance

Tools

Microsoft Office

Smartsheet

Claims processing systems

Job description

Prominence Health, part of Universal Health Services, is seeking a Manager of Fraud, Waste, Abuse to lead its FWA, Subrogation, and Payment Integrity programs. You will direct investigations, recoveries, and cost-containment initiatives while collaborating across departments and external partners to ensure compliance and accuracy.

The role emphasizes coordination of benefits, MSP efforts, and timely resolution of opportunities, with focus on data-driven decision-making and regulatory adherence.