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Manager, Special Investigations Unit

HMSA, Honolulu, HI, United States

Duration: Full Time


  1. Program Oversight/Leadership for FWA SIU:


    • Provide strategic oversight of the FWA SIU program

    • Ensure compliance with all applicable FWA regulatory requirements

    • Maintain independence and objectivity of SIU investigations

    • Oversee intake, prioritization, and outcomes of investigations

    • Review and approve investigative findings and referrals

    • Escalate significant FWA risks to executive leadership

    • Oversee vendor and delegated FWA/SIU activities

    • Monitor FWA trends, metrics, and program effectiveness

    • Oversee FWA related reporting

    • Support audit readiness and regulatory inquiries



  2. Cross-Functional Team Partnerships:


    • Partner with Compliance to ensure regulatory alignment and audit readiness

    • Collaborate with Medical Management on utilization and clinical FWA risks

    • Coordinate with Provider Relations on provider actions and remediation

    • Work with Finance on recoveries, overpayments, and financial reporting

    • Coordinate with Legal as appropriate on investigations, and enforcement actions

    • Support Operations with FWA education, guidance, and risk mitigation

    • Coordinate with delegated entities and vendors on FWA oversight and reporting

    • Serve as the primary SIU liaison to internal and external stakeholders



  3. Leadership:


    • Selects, trains, develops and organizes staff.

    • Monitors overall inventory of work and prioritizes the staff's work to meet performance standards and authorizes additional resources as needed.

    • Provides feedback and coaching (helping individuals to solve problems/issues on their own) including timely completion of any interim and year-end performance reviews.



  4. Performs all other miscellaneous responsibilities and duties as assigned or directed.




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