Manager - Special Investigations (SIU)

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees.

About the role

This position is responsible for supervising, training, and the overall performance of Medica’s Special Investigations Unit (SIU) investigative staff. Additionally, this position prepares reports and statistical dashboards for all SIU business functions. The Manager works collaboratively with the Director of Special Investigations to design and produce reports on SIU activity for other Medica business units, as well as develop educational communication to raise awareness of fraud, waste, and abuse detection and prevention at Medica.

The Manager must be customer-focused, able to multitask, retain a large amount of knowledge, have strong organizational skills, and enjoy working in a team environment. This individual will respond to customers with a high level of accuracy and timely follow-up. In written responses, the Manager must work proactively with SIU staff and business segment leadership to anticipate emerging patterns of fraud and abuse and collaborate to develop strategies to reduce any business impact to Medica.

The Manager will utilize online tools and resources to efficiently and effectively identify potential fraud or abuse in claims data. This position requires sensitivity, understanding, and the knowledge and resources to quickly resolve problems. The Manager is responsible for building solid relationships with leaders in other departments (Compliance, Government Programs, Individual and Family Business, and Operations). Excellent verbal and written communication and interpersonal skills are required to effectively collaborate with other internal Medica departments as well as external parties.

Responsibilities

• Manage performance and hold staff accountable for meeting department standards for quality, turnaround time, and attendance.
• Formulate action plans for substandard performance.
• Conduct regular one-on-ones with team members.
• Establish annual goals and objectives for the team, ensure quarterly check-ins are completed, and prepare and present Performance Reviews.
• Clearly communicate team and individual expectations.
• Ensure all team members have the training and tools they need to perform the job successfully.
• Collaborate with leaders and others as appropriate within the organization to ensure consistent, effective, and timely communication and problem resolution.
• Coach, encourage, and facilitate individual growth and development through specific, timely, and consistent feedback. Promote a coaching culture.
• Backup and support SIU Director, as needed, in various meetings, projects, and work groups.
• Provide technical support to staff by researching and responding to their questions. Provide insight and offer suggestions/solutions to team issues.
• Review incoming referrals and, as appropriate, assign for investigation and follow-up.
• Review investigations closed by investigative staff to ensure that the investigation was thorough and the investigative outcome is appropriate.
• Produce a monthly statistical dashboard of investigative activity for distribution to segment leaders.
• Prepare monthly, quarterly, and annual SIU investigation summary reports for various internal Medica compliance committee meetings, Medica’s Board of Directors, and Medica leadership.

Requirements

• Bachelor's degree or equivalent.
• 5 years of healthcare, insurance, or law enforcement investigative experience.
• 2 years of leadership experience.

Preferred Qualifications

• Excellent verbal and written communication skills.
• Excellent interpersonal skills and the ability to handle ambiguity.
• Analytical/problem-solving and presentation skills.
• Organized and able to multi-task.
• Highly motivated and self-starter.
• Customer-focused.
• Working knowledge of regulatory enforcement environment.
• Ability to identify, trend, and analyze data for communication and process improvements.
• Proficient with Microsoft Office Suite.

Schedule

This position is an Office role, which requires an employee to work onsite at our Minnetonka, MN office, on average, 3 days per week.

Pay

The full salary grade for this position is $78,700 - $134,900. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $78,700 - $118,020. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity, and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation.

Benefits

Medica offers a generous total rewards package that includes:

• Competitive medical, dental, and vision coverage.
• Paid time off (PTO) and holidays.
• Paid volunteer time off.
• 401K contributions.
• Caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.