Senior Medicaid Program Integrity Lead – Iowa

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

Job summary

Sun Life DentaQuest in Des Moines, Iowa, seeks an experienced Iowa Program Integrity Manager to lead Medicaid program integrity, oversee SIU activities, and drive fraud prevention efforts. You will collaborate with state agencies, CMS, and law enforcement to implement robust strategies and ensure compliant investigations.

The role requires senior healthcare and program integrity expertise, strong data analysis, and a track record of cross-functional leadership in a large health plan.

Qualifications

• Must reside in Iowa.
• Bachelor’s degree required.
• 9+ years of experience in compliance, legal or regulatory functions or equivalent.
• Demonstrate knowledge of health care delivery, program integrity, utilization management, or public health program functions in large health plans.
• Comprehensive knowledge of Medicaid laws and regulations.

Responsibilities

• Provide leadership and strategic oversight of DentaQuest Program Integrity and SIU activities.
• Oversee Fraud, Prevention, and Recovery operations to prevent, detect and investigate abuse.
• Collaborate with Clinical Quality Management to improve prevention activities.
• Develop and improve program integrity strategies aligned with Iowa Medicaid rules.
• Perform advanced data analysis to identify utilization trends and risks.
• Coordinate with state Medicaid, CMS, law enforcement, and managed care.
• Ensure investigations and policy updates are properly documented and defensible.
• Serve as primary liaison for client meetings and reporting.
• Track investigations and manage workflows to meet client requirements.
• Support policy improvements and cross-department collaboration.

Skills

Leadership

Regulatory compliance

Data analysis

Policy writing

Collaboration

Communication

Problem solving

Project management

Presentation skills

Attention to detail

Education

Bachelor’s degree

Tools

Excel

PowerPoint

Job description

Sun Life DentaQuest in Des Moines, Iowa, seeks an experienced Iowa Program Integrity Manager to lead Medicaid program integrity, oversee SIU activities, and drive fraud prevention efforts. You will collaborate with state agencies, CMS, and law enforcement to implement robust strategies and ensure compliant investigations.

The role requires senior healthcare and program integrity expertise, strong data analysis, and a track record of cross-functional leadership in a large health plan.