Special Investigative Unit Coordinator

We are seeking a Special Investigative Unit Coordinator to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Special Investigative Unit (SIU) Coordinator plays an essential role in overseeing and managing investigations related to fraud, abuse, and other compliance issues within the healthcare and social assistance sector. This position ensures that all investigative activities are conducted thoroughly, ethically, and in accordance with regulatory standards and organizational policies. The Special Investigative Unit (SIU) Coordinator acts as a liaison between internal departments, external agencies, and legal entities to facilitate information sharing and resolution of cases. By leading a team of investigators, the Special Investigative Unit (SIU) Coordinator ensures timely and accurate documentation, analysis, and reporting of findings to support corrective actions and risk mitigation. Ultimately, this role contributes to safeguarding organizational integrity, protecting members rights, and maintaining compliance with healthcare laws and regulations.

Minimum Qualifications:

• Bachelor's degree in Criminal Justice, Healthcare Administration, Social Work, or a related field.
• Minimum of 3 years of experience in healthcare investigations, compliance, or a related area.
• Strong knowledge of healthcare laws, regulations, and compliance standards including HIPAA and Medicare/Medicaid rules.
• Proven experience in managing investigative teams or projects.
• Relevant Experience may substitute for educational requirement on a year-for-year basis.

Preferred Qualifications:

• Master's degree in Criminal Justice, Healthcare Administration, Social Work, or a related field.
• Certification in Fraud Examination (CFE) or Healthcare Compliance (CHC) is highly desirable.
• Experience working within a Special Investigative Unit or similar healthcare fraud prevention team.
• Familiarity with data analytics tools and investigative software.
• Advanced degree in a relevant field such as Public Health, Law, or Business Administration.
• Demonstrated ability to work collaboratively with law enforcement and regulatory agencies.

Responsibilities:

• Demonstrates commitment to Our Mission and models that ILS Standards of Excellence.
• Manage and coordinate investigations of suspected fraud, waste, and abuse within healthcare programs, ensuring compliance with legal and regulatory requirements.
• Develop and implement investigative plans while maintaining confidentiality and security of sensitive information.
• Supervise, train, and support investigative staff, overseeing performance, case management, and professional development.
• Collaborate with internal departments and external agencies, including compliance, legal, clinical teams, law enforcement, and regulators.
• Prepare detailed reports, track investigative trends, and present findings to leadership, recommending policy or procedural changes to strengthen compliance and risk management.
• Performs other duties as assigned.