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Team Lead, Program Integrity (Triage) at CareSource - ApplyBlast

Team Lead, Program Integrity (Triage)

CareSource

3 months ago

3.5 on Glassdoor

Onsite

Full Time

Senior

0 applicants

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About this role

The Team Lead, Program Integrity leads investigative staff to reduce turnaround time and produce positive outcomes in healthcare fraud investigations. The role involves assigning cases, monitoring workflow allocation, mentoring direct reports, and implementing standard operating procedures to mitigate financial risk. Additionally, the position collaborates cross-functionally to identify fraud areas, assist in regulatory audits, and integrate AI-enabled workflows.

Responsibilities

Direct day-to-day activities and leadership of investigative staff
Assign cases and monitor investigation allocation to maximize output
Identify knowledge gaps and provide training opportunities to direct reports
Develop and implement internal departmental standard operating procedures
Collaborate cross-functionally to identify potential areas of fraud and abuse

Skills

Qualifications

Bachelor's degree in Health-Related Field, Law Enforcement, or InsuranceAccredited Healthcare Fraud Investigator (AHFI)Certified Fraud Examiner (CFE)Certified Professional Coder (CPC)

About CareSource

caresource.com

Headquarters

Dayton, Ohio, United States

Company Size

1001-5000 employees

Founded

1989

View Profile

CareSource is a nonprofit managed care organization that provides health insurance plans and related healthcare services, primarily through Medicaid, Medicare, and Marketplace offerings. The company works with members, providers, and government partners to deliver access to medical, behavioral health, and care management services in the health insurance industry.