We are looking for an experienced Risk Manager to support fraud, waste, and abuse oversight for a healthcare organization in Sunrise, Florida. This Long-term Contract position focuses on protecting program integrity through investigations, compliance monitoring, data analysis, and collaboration with regulatory and enforcement partners. The role is well suited to an individual who is detail oriented and can manage sensitive cases, interpret complex requirements, and drive recovery opportunities with accuracy and professionalism.

Responsibilities:

Lead fraud, waste, and abuse oversight activities to strengthen program integrity and support healthcare risk management objectives. Build and maintain effective working relationships with Medicaid program integrity representatives, including participation in collaborative meetings and timely responses to inquiries. Direct investigative case management from initial referral through documentation, resolution, reporting, and recovery follow-up. Use data mining, claims analysis, and pattern review to identify suspicious billing activity, unusual utilization trends, and new investigation opportunities. Conduct detailed investigations involving providers, members, subcontractors, and other relevant parties while ensuring complete and well-supported case records. Prepare clear investigative summaries, audit findings, and regulatory reports covering all stages of case development and outcomes. Coordinate with compliance partners, public agencies, law enforcement, and oversight entities to support referrals, information requests, and enforcement actions. Monitor adherence to state and federal fraud prevention requirements and communicate applicable obligations to internal teams and external stakeholders. Support overpayment recovery efforts by identifying financial exposure, documenting findings, and working with appropriate parties to pursue resolution. Perform additional risk and compliance duties as needed to meet departmental priorities and business needs. At least 1 year of experience in risk management, fraud investigation, compliance investigations, or healthcare program integrity. Background in healthcare fraud, anti-fraud operations, fraud analytics, or related investigative work within a regulated environment. Knowledge of risk analysis, risk management strategies, and compliance management practices. Ability to perform data mining and interpret claims or billing patterns to detect potential fraud, waste, or abuse. Familiarity with state and federal regulatory requirements tied to investigations, compliance functions, and reporting obligations. Strong due diligence, documentation, interviewing, and analytical skills with careful attention to detail. Ability to communicate findings clearly to providers, internal stakeholders, regulatory contacts, and external partners. Experience collaborating across compliance, audit, and investigative teams while managing multiple priorities effectively. Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app and get 1-tap apply, notifications of AI-matched jobs, and much more. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking "Apply Now," you're agreeing to Robert Half's Terms of Use and Privacy Notice .