Medicaid Program Integrity Leader

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

Benefits offered by this job

Vacation & sick time

Medical coverage

401(k) match

Stock purchase options

Sabbatical program

Job summary

Sun Life U.S. is seeking a senior Program Integrity Manager based in Des Moines, IA, to lead Medicaid managed care program integrity and special investigations. This role partners with state and federal agencies to prevent fraud, waste, and abuse, ensuring compliant investigations and data-driven oversight.

Hybrid work model with 2 days in the Des Moines office. Ideal candidate has 9+ years in health-care compliance, strong policy writing, and cross-agency collaboration.

Qualifications

• Bachelor's degree required.
• 9+ years of experience in compliance, legal or regulatory functions.
• Knowledge of Medicaid laws and regulations.
• Ability to analyze data and drive program integrity actions.
• Strong writing and communication skills.

Responsibilities

• Provide leadership and strategic oversight of program integrity and SIU activities.
• Collaborate with state Medicaid agencies, CMS, and law enforcement.
• Develop and implement program integrity strategies aligned with Iowa Medicaid rules.
• Perform advanced data analysis to identify utilization trends and risks.
• Serve as liaison between Sun Life DentaQuest and Iowa Health and Human Services.
• Track investigations and manage client reporting requirements.

Skills

Leadership

Data analysis

Regulatory compliance

Policy development

Stakeholder management

Education

Bachelor's degree

Tools

PowerPoint

Excel

Job description

Sun Life U.S. is seeking a senior Program Integrity Manager based in Des Moines, IA, to lead Medicaid managed care program integrity and special investigations. This role partners with state and federal agencies to prevent fraud, waste, and abuse, ensuring compliant investigations and data-driven oversight.

Hybrid work model with 2 days in the Des Moines office. Ideal candidate has 9+ years in health-care compliance, strong policy writing, and cross-agency collaboration.