[Hiring] SIU Compliance Manager @RGP

Role Description

Our healthcare payer client needs additional SIU (Special Investigations Unit) support to handle a heavy caseload of fraud, waste, and abuse (FWA) investigations. The role is critical for maintaining compliance with state and federal regulations and ensuring claims integrity.

Pay Range: $45-60/hour W2 + benefits | 6-12-month project opportunity

Key Responsibilities

• Review medical records, claims, and supporting documentation for clinical consistency, completeness, and compliance.
• Identify potential indicators of fraud, waste, and abuse, including:
  • Cloning of medical documentation
  • Upcoding
  • Billing inconsistencies
  • Unsupported services and procedures
  • Medical necessity concerns
• Conduct initial reviews and assessments of complex healthcare cases to determine potential compliance risks.
• Analyze documentation to validate medical necessity and appropriateness of billed services.
• Collaborate with SIU investigators and leadership to support ongoing investigations.
• Document findings and provide clear recommendations for further review or action.
• Stay informed of healthcare regulations, billing guidelines, and industry best practices.

Qualifications

• Experience in healthcare investigations, healthcare compliance, SIU, clinical auditing, utilization review, medical record review, or related healthcare oversight functions.
• Strong understanding of medical necessity criteria and healthcare documentation standards.
• Knowledge of healthcare fraud schemes, billing practices, and claims review methodologies.
• Experience reviewing complex medical records and identifying documentation discrepancies.
• Ability to analyze clinical information and communicate findings effectively.

Preferred Background

• Clinical background strongly preferred.
• Experience in healthcare payer, managed care, SIU, fraud investigations, clinical auditing, or healthcare compliance environments is highly desirable.

Benefits

• Medical
• Dental
• Vision
• Life Insurance
• Disability Insurance
• 401(k) Savings Plan
• Employee Stock Purchase Plan
• Professional Development Program
• Paid Time Off
• Paid Sick Time (in geographies where legally required)

Company Description

At RGP, we're creating a future where businesses produce their best work without constraints. We've built a global network of over 2,600 experts across four regions, providing a comprehensive suite of solutions across on-demand talent, next-generation consulting, and outsourced services to support organizations at every stage of their growth journey.

RGP is proud to be an Equal Opportunity Employer and committed to creating an inclusive environment for all employees.