Hybrid Iowa Medicaid Program Integrity Leader

Sun Life; Des Moines (IA); Hybrid; USD 77,000 - 116,000; Full time

Benefits offered by this job

Vacation and sick time

Family leave (maternity/paternity)

Medical coverage

Life and AD&D insurance

Disability programs

Sabbatical program

401(k) match

Stock purchase options

Job summary

Sun Life U.S. is a leading benefits provider with a national footprint in Des Moines, IA.

The Iowa Program Integrity Manager will lead the Medicaid program integrity operation, directing investigations and strategic initiatives to prevent fraud, waste, and abuse. You will work with state and federal partners, healthcare programs, and DentaQuest to safeguard Medicaid programs, while reporting to the Director of Regulatory Compliance & Program Integrity.

Qualifications

• 9+ years of experience in compliance, legal or regulatory functions or related fields.
• Demonstrated knowledge of health care delivery and program integrity within large health plans.
• Ability to interpret laws and regulations and communicate them to management.

Responsibilities

• Provide leadership and strategic oversight of SIU activities.
• Collaborate with fraud prevention and recovery operations to prevent fraud, waste and abuse.
• Develop and implement program integrity strategies aligned with Medicaid rules.
• Perform advanced data analysis to identify trends and risks.
• Coordinate with state Medicaid agencies, CMS, and law enforcement.
• Ensure investigative actions comply with CMS rules and internal policies.

Skills

Strong writing skills

Verbal communication

Analytical thinking

Problem-solving

Collaboration

Education

Bachelor's degree from an accredited four-year college or university

Tools

PowerPoint

Excel

Job description

Sun Life U.S. is a leading benefits provider with a national footprint in Des Moines, IA.

The Iowa Program Integrity Manager will lead the Medicaid program integrity operation, directing investigations and strategic initiatives to prevent fraud, waste, and abuse. You will work with state and federal partners, healthcare programs, and DentaQuest to safeguard Medicaid programs, while reporting to the Director of Regulatory Compliance & Program Integrity.