Vice President, Government and Commercial Programs

Company Overview:

Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you’re ready to grow with the best, explore a career with us and make a difference.

This is a hybrid work remote role.

Allied Universal® is hiring a Vice President, Government and Commercial Programs. The Vice President, Government and Commercial Programs is responsible for all government and commercial healthcare operations in addition to managing interactions with government entities while concurrently developing and executing strategies to drive commercial growth and Profit & Loss (P&L) responsibility across both public and private sectors. The Vice President, Government and Commercial Programs will expect some overnight travel within the United States.

RESPONSIBILITIES:

• Oversee the strategic direction and function of Government and Commercial Programs within the Advize operations line of business including P&L oversight to achieve organizational goals
• Responsible for the day-to-day oversight of the operational efficiency and effectiveness of the clinical auditing, compliance and special investigations unit organization, to include special programs such as Physician, Managed Care, Pharmacy, PACE, and Special Needs
• Create and implement Process Improvement strategies resulting in best-in-class concept management processes to improve fraud, waste and abuse
• Act as subject matter expert related to government acquisition processes, rules, and regulations
• Serve as needed as experienced witness for litigation and federal cases, providing expert testimony in complex fraud, waste and abuse legal proceedings

QUALIFICATIONS (MUST HAVE):

• Must possess one of the following:
• Bachelor’s degree in Healthcare Administration, Nursing, or Business
• Associate’s degree in Healthcare Administration, Nursing, or Business with a minimum of fifteen (15) years of experience in healthcare leadership roles
• Must possess, or be able to obtain, a government security clearance
• Minimum of twelve (12) years of experience in P&L and/or business oversight, inclusive of a combination of healthcare and cost management analytics, specializing in payment integrity, fraud waste and abuse programs
• Minimum of twelve (12) years of experience in progressive healthcare leadership roles
• Demonstrated ability to win new business within government contracting and commercial sectors
• Ability to effectively partner with law enforcement and regulatory agencies to report fraud and abuse, ensuring adherence to industry standards and regulations
• Knowledge of healthcare regulation and compliance policies as well as medical terminology
• Excellent analytical and critical thinking skills
• Proficiency in Microsoft Office
• Ability to remain highly productive in a changing environment, strong attention to detail, organizational skills, and maintain a high level of discretion with sensitive information
• Effectively oral and written communication skills

PREFERRED QUALIFICATIONS (NICE TO HAVE):

• Master’s degree in Healthcare Administration, Nursing, or Business

BENEFITS:

• Medical, dental, vision, basic life, AD&D, retirement plan and disability insurance
• Seven paid holidays annually, sick days available where required by law
• Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law

Annual Salary Range - $130,000 - $160,000 depending on geographic location

Allied Universal® is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com

If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.