Overview

We are looking for a dynamic and experienced Sr. Director of Engineering to lead our Fraud Division. The Director, Fraud, Waste, and Abuse (FWA) will oversee Cotiviti’s Prospective FWA Services team, inclusive of managers, supervisors, team leaders and corresponding investigators/coders. Through this work, the successful candidate will drive innovation of our Prospective FWA product line to meet the evolving needs of our clients and prospects, including potential new markets. The successful candidate will demonstrate a unique blend of leadership, creativity, business judgment, entrepreneurial spirit, health care industry knowledge and experience, and prospective FWA operational domain expertise.

Responsibilities

• Manage the prospective FWA services team, including our international operations partners.
• Develop standard operating procedures for the prospective team.
• Collaborate with Client Executives, Client Services Managers and FWA Management staff in client and daily operational oversight of the prospective FWA function.
• Work with existing customers and prospects to understand experiences to date and future requirements in a systematic way to develop strategic product responses, rather than on-off client fixes.
• Train and mentor staff managers and provide training related to management and leadership competencies.
• Develop and maintain policies and procedures for operational processes in order to ensure optimization, efficiency and compliance with established standards, regulations and best practices. Promote and socialize best practices in all areas of clinical operations.
• Collaborate with account management, IT, and other applicable departments to ensure client expectations are met. Participate in client meetings and sales calls as subject matter expert for areas of responsibility. Participate in development of SOWs, RFPs, and approve all contract SOW/SLA’s for respective areas prior to execution.
• Oversee the work of Managers, Team leads, Coders, Investigators and/or support staff.
• Ensure compliance with customer contracts.
• Oversee recruiting, hiring, training and orientation of new staff; and assure consistency with ongoing staff training and development.

Qualifications

• Bachelor’s degree in computer science, information technology, or related field of study is required. Master's Degree preferred.
• 8-10 years experience in health care analytics (fraud, waste, and abuse preferred) including experience in software product management with a preference for healthcare product management experience (experience as a user of health care data analytics technologies is also relevant)
• Exposure to/experience across payer, provider, government, and employer (direct & channel), perspectives a strong plus
• Familiarity with FWA modeling methodologies and other products highly desirable
• Knowledge of critical health care data sets and coding systems (e.g., claims, clinical, lab, etc.)
• 4+ years of management experience leading teams
• Understanding of agile product management process and ability to work cross-functionally to institute process change in product release to improve overall quality of releases
• Deep understanding of the FWA analytics and related (e.g., performance management, risk adjustment, quality improvement) business needs of our clients across employer, payer, and provider space, including challenges they face from health care reform and other industry trends occurring. Ability to translate these needs into concrete product initiatives with strong business cases supporting decisions, including understanding of key specific user personas and their definitions of value
• The ability to credibly interface with internal and external senior executives, including the ability to communicate with non-management stakeholders effectively
• A track record and innate desire to build outstanding, motivated and productive teams by identifying and hiring A-players, investing in coaching and feedback, communicating transparently, and providing high energy leadership
• Strong problem solving skills with ability to guide development of analytical models to support business decisions
• Ability and presence to work with senior executives (internal, clients, prospects) in a consultative manner to solve their business problems through our current tools and future development initiatives
• Certifications in fraud related fields a big plus.
• May require travel

Base compensation ranges from $159,500 to $220,000. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

This role is based remotely and all interviews will be conducted virtually.

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