Vice President, Special Investigations

A company is looking for a Vice President, Special Investigations Unit.

Key Responsibilities

Lead and support an enterprise-wide team to detect, investigate, and mitigate fraud, waste, and abuse (FWA) across all business lines

Develop and execute a forward-looking FWA investigation strategy aligned with regulatory obligations and business priorities

Oversee the intake, triage, investigation, and resolution of suspected FWA cases while ensuring compliance with federal and state mandates

Required Qualifications, Training, and Education

Bachelor's degree in business administration, Healthcare Administration, Law, or related field required; Master's degree or Juris Doctor preferred

10+ years of progressive experience in fraud investigations, healthcare compliance, or regulatory enforcement required

Significant experience managing large-scale FWA programs in a health plan, payer, government agency, or consulting firm required

Deep knowledge of federal and state health programs and FWA regulatory frameworks required

Proven leadership experience with cross-functional teams and external regulators required