Director, Fraud Detection & Prevention

Director, Fraud Detection & Prevention

The Director, Fraud Detection & Prevention plays a critical leadership role in driving the organization's strategy to identify, mitigate, and address instances of fraud, inefficiency, and abuse. This position leads the Special Investigations Unit (SIU), oversees high-level investigations, and ensures adherence to all applicable federal and state regulations, including those governing Medicare and Medicaid programs.

Location : Must reside in the St. Louis, MO area. This is a hybrid role of work from home and in office work at our Lake St. Louis, MO office location.

What you'll do :

• Develop and implement a comprehensive FWA prevention and detection program across the organization
• Lead investigations into suspected fraud, waste, or abuse, ensuring timely resolution and appropriate corrective actions
• Draft, revise, and enforce FWA-related policies and procedures
• Design and deliver targeted training programs for high-risk departments and roles
• Develop dashboards and KPIs to monitor FWA trends and program effectiveness
• Leverage predictive analytics, AI tools, and forensic software to proactively detect anomalies and suspicious patterns
• Establish and maintain reporting mechanisms for suspected FWA, including anonymous hotlines and digital platforms
• Monitor industry trends, regulatory changes, and geopolitical risks that may impact FWA exposure
• Conduct risk assessments and data analytics to identify patterns and vulnerabilities
• Oversee training and awareness programs to educate employees on FWA policies and ethical conduct
• Prepare detailed reports for executive leadership
• Ensure compliance with federal, state, and industry-specific regulations (e.g., HIPAA, CMS, DOJ guidelines)
• Monitor emerging threats and trends in fraud and abuse, adapting strategies accordingly
• Other duties as assigned

What you'll need :

Experience, Education & Certifications :

Skills :

Even better if you have...

What's in it for you :

Equal Opportunity Employer : MTM is an equal opportunity employer. MTM considers qualified candidates with a criminal history in a manner consistent with the requirements of applicable local, State, and Federal law. If you are in need of accommodations, please contact MTM's People & Culture.