Investigations Manager

Georgia Power Company; Atlanta (GA); On-site; USD 56,000 - 80,000; Full time

Job summary

State of Georgia, Department of Community Health, is seeking an Investigations Manager to oversee the Program Integrity Unit and Office of Inspector General. The role directs two direct reports and leads investigations into fraud, waste, and abuse within the Fee-for-Service Medicaid program across Georgia.

The manager analyzes claims data to identify aberrant billing and leads on-site investigations, records requests, and interviews, ensuring timely adherence to performance metrics and providing

Qualifications

• Bachelor's degree in operations management, business administration, or related field with at least 3 years in a managerial role.
• Seven years of related professional experience with at least 3 years in a managerial role.
• Equivalent combination of education and experience may be substituted per policy.

Responsibilities

• Manage two direct reports investigating providers for fraud, waste, and abuse in Medicaid.
• Analyze claims data to identify aberrant billing trends for utilization review.
• Conduct on-site provider visits across Georgia to request medical records and inspect facilities.
• Review documentation for Participant and Consumer Directed Care services to investigate false claims.
• Review referrals and hotline complaints and participate in Surveillance Utilization Review meetings.

Skills

Managerial experience

Supervisory leadership

Data analysis

Education

Bachelor's degree in operations management, business administration, or related field

Job description

Investigations Manager# Team Georgia Careers## Investigations ManagerApply: Atlanta: Full time: Posted Today: End Date: November 11, 2026 (12 days left to apply): JR0000004059Explore a World of Opportunity with the State of Georgia!We are the force that drives Georgia! Georgia State Government is a large enterprise, composed of various agencies and entities with a common goal to improve the lives of Georgia's more than 10 million citizens! Join Team Georgia and impact lives everyday while receiving a robust benefits package designed for every stage of your career! **Job Title:**Investigations Manager**Agency:**Department of Community Health**Job Requisition ID:**JR0000004059**Shift:**Not Applicable (United States of America)**Compensation Details:**$56,310.72 - $80,000**Job Description:**The position provides critical support functions within the Program Integrity Unit and the Office of Inspector General, which helps safeguard the agency from fraud, waste, and abuse. The selected candidate will be responsible for managing two (2) direct reports charged with investigating providers for fraud, waste, and abuse in the Fee-for-Service Medicaid program. The Investigations Manager provides guidance and feedback to the team to ensure adherence to performance metrics and timeliness of business processes for the Program Integrity Unit. The Investigations Manager analyzes claims data to identify aberrant billing trends for providers to facilitate utilization review. The Investigations Manager conducts and leads provider on sites throughout Georgia to request medical records, conduct interviews, and tour facilities to ensure appropriate medical equipment is onsite to support services billed to Medicaid. The Investigations Manager reviews documentation for Participant and Consumer Directed Care services to investigate allegations of false claims billed to Medicaid. The Investigations Manager reviews referrals, hotline complaints, and participates in Surveillance Utilization Review meetings to identify providers for utilization review**Minimum Qualifications:**Bachelor's degree in operations management, business administration, or a related field which includes three (3) years in a managerial or supervisory role; or seven (7) years of related professional experience which includes three (3) years in a managerial or supervisory role; or three (3) years of experience required at the lower level Mgr, Business Ops (GSM010) or position equivalent.--Note: An equivalent combination of knowledge, education, job or intern experience, training, or certifications that provides the necessary knowledge and skills to successfully perform the job at the level listed may be substituted year-over-year.