Director of Special Investigations

Flex IL - Chicago TX - Richardson Full time

R0055260

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary The Director of Special Investigations will lead the Special Investigations Department (SID) in Texas, Oklahoma, and New Mexico. In addition to directing all healthcare fraud investigations within these states, this position will oversee SID's Enterprise-Wide Intelligence Unit, which is primarily responsible for identifying healthcare fraud schemes. SID's primary mission is to seek the criminal prosecution of individuals and entities that defraud HCSC and its customers. This position will serve as the primary liaison with the FBI, the U.S. Department of Health and Human Services (HHS), and other law enforcement agencies. The Director will also partner with other HCSC departments, including Legal, Medical, and Network, on civil and criminal matters related to SID investigations. Additionally, this position will be responsible for audit and compliance activities related to SID operations. The Director will oversee the development and management of the SID budget and related financial activities for Texas, Oklahoma, and New Mexico.

JOB REQUIREMENTS:

Bachelor Degree. 10 years experience in law enforcement or conducting complex health care fraud or white collar fraud investigations . 4 years of managerial experience. Administrative and organizational skills. Clear and concise verbal, written, and interpersonal communication. Experience developing and maintaining effective liaison relationships. Translating needs and initiatives into compelling business cases. Conducting cost-benefit analyses to justify investments and ensure ROI.

PFREFERRED JOB REQUIREMENTS:

Experience in the administration of government programs. Management and administration of health care fraud investigations. Master’s Degree Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law. Base Pay Range $121,200.00 - $225,200.00 Exact compensation may vary based on skills, experience, and location. For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at View phone number on click.appcast.io to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2025 Health Care Service Corporation. All Rights Reserved. #J-18808-Ljbffr HCSC