Director, Fraud & Abuse Services

Occupations

Job Description

Director, Fraud & Abuse Services
Grand Rapids or Farmington Hills

Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact health care costs while maximizing customer experience. It offers a broad portfolio of products for employer groups, individuals and Medicare and Medicaid. As a nonprofit company, Priority Health serves more than 600,000 people and continues to be ranked among America’s best health plans by the National Committee for Quality Assurance.

Priority Health is seeking a proactive, passionate person to lead their Fraud and Abuse Services. The Director, Fraud and Abuse Services will be responsible for defining, implementing and promoting organization-wide loss prevention to detect and eliminate unnecessary medical expense. This position will aggressively oversee comprehensive fraud investigation, auditing and recovery.

The ideal candidate will be solutions-driven and able to provide leadership for the Fraud and Abuse Services, Cost Recovery and Medical Coding Teams to ensure consistent focus and optimal performance. Strong analytic and communication skills, coupled with experience managing fraud and abuse programs in managed care, pharmaceutical, health insurance or a related organization are essential.

Job Requirements