Manager Special Investigations

Job Summary

HCSC is seeking a dynamic individual to join its Fraud Investigations team, responsible for managing healthcare fraud and internal fraud investigations, initially focusing on IL Medicaid. The role includes managing and training investigators and support staff, establishing and maintaining liaison with healthcare providers and law enforcement, and coordinating anti‑fraud activities with other HCSC departments. The position is hybrid flex, requiring in‑office presence three days per week and remote work two days.

Relocation and sponsorship are not offered.

• Bachelor’s Degree in Criminal Justice, Finance or Accounting or a related field.
• 5 years of direct law enforcement/investigation experience, including supervision of cases and investigators,
  ** or
  * * 9 years of direct professional work experience in the detection, investigation, and/or prosecution of complex health care fraud schemes.
• Professional certifications such as Accredited Healthcare Fraud Investigator (AHFI), Certified Professional Coder (CPC), and/or Certified Fraud Examiner (CFE) are required.
• 1 year of leadership or supervisory experience.
• Strong organizational, analytical, interviewing, and investigative skills, proficiency in data analysis and claims management systems.
• Deep understanding of insurance fraud techniques, claims handling, and regulatory compliance.
• Proficiency with anti‑fraud analytics tools, case management software, and MS Office (Word, Excel, PowerPoint) as well as Workday.

• Master’s Degree.
• Experience with IL Medicaid FWA investigations.

• Develop and manage investigative group designed to detect, investigate, and refer health care fraud cases to law enforcement.
• Ensure evidence collected, including documents and interview reports, is maintained with integrity for court proceedings.
• Ensure personnel are properly trained and managed in investigative techniques.
• Prepare weekly investigative and activity reports.
• Coordinate with other HCSC departments concerning ongoing anti‑fraud programs and procedures.
• Develop and maintain sources of information needed to detect health care fraud.
• Develop and maintain liaison contacts with law enforcement.
• Direct and supervise sensitive investigations when appropriate.
• Deal directly with HCSC customers on fraud matters when appropriate.
• Conduct monthly file reviews and provide direction to investigators regarding investigative strategies and plans.
• Coordinate investigative activities with the Legal Department.
• Ensure investigators are familiar with and utilize health care fraud databases, including Fraud and Abuse Management System (FAMS).
• Comply with federal and state reporting and fraud investigation requirements.
• Communicate and interact effectively and professionally with co‑workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company business.
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

Base Pay Range: $92,700.00 - $ (exact compensation may vary based on skills, experience, and location).
HCSC Employment Statement:
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.