Program Manager, Investigation Services

Role overview

Position responsibilities

• Lead, coach, and develop analysts while fostering sound investigative judgment, collaboration, and accountability.
• Provide guidance on complex, sensitive, or high-risk files, from investigation strategy and evidence assessment to documentation and recommendations.
• Promote consistent investigative practices, support analysts with challenging files, and develop team capabilities.
• Identify fraud risks, trends, and opportunities; work with internal partners on appropriate responses.
• Build stakeholder relationships, improve processes, tools, controls, and practices, and support an inclusive, high-performing team.

Required qualifications

• Experience conducting insurance investigations and strong understanding of investigative methodology and case development.
• Experience with dental, drug, health benefits, or provider investigations; knowledge of health and dental claims, provider practices, or related fraud risks.
• Informal or formal leadership experience, including mentoring, coaching, leading complex investigations, or serving as a subject-matter expert.
• Experience using data and analytics for fraud detection or investigations.
• Fraud- or investigation-related education, training, or professional designation.

Preferred qualifications

• Experience managing complex investigations, including evidence gathering, interviews, findings, and recommendations.
• Strong investigative judgment, critical thinking, problem-solving, and analytical skills.
• Ability to coach, influence, provide constructive feedback, build trust, and support others’ development.
• Strong communication, collaboration, discretion, organization, and ability to manage competing priorities.

Work arrangement

• The posting includes the hashtag #LI-HYBRID.

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