Sr. Manager, Major Case Investigative Unit (Medical & Provider Fraud)

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    "createdOn": "2026-04-29T14:14:41.243000-07:00",
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      "role": "<meta><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;\"><b><strong style=\"white-space:pre-wrap;\">The Opportunity</strong></b></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;\"><br></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">We are seeking a highly analytical and strategic Senior Manager - Major Case Investigative Unit to lead our fight against insurance fraud. In this newly created role, you will bridge the gap between First Party Medical (FPM) operations and the Special Investigative Unit (SIU). Your role will be to collaborate closely with SIU and FPM leadership to drive cross-functional projects and business solutions. Your primary mission will be to aggressively identify, investigate, and combat 1st and 3rd party medical fraud, with a specialized focus on complex provider fraud rings and schemes.</span></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;\"><br></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">You will lead a specialized team of claims leaders, ensuring a balance of quality, efficiency, customer experience, and employee engagement. The ideal candidate brings deep technical expertise in high-risk jurisdictions (preferably NY, MI, NJ, FL) and a proven track record of developing leaders who can disrupt large-scale medical fraud operations.</span></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;\"><br></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;text-align:left;\"><b><strong style=\"white-space:pre-wrap;\">Salary Range</strong></b><span style=\"white-space:pre-wrap;\">: &nbsp;$117,300 - $146,600 (Bonus &amp; LTI Eligible)</span><br><br><span style=\"white-space:pre-wrap;\">Root is a “work where it works best” company. Meaning we will support you working in whatever location that works best for you across the US. We will continue to have our headquarters in Columbus, Ohio.</span></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;\"><br></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;text-align:left;\"><b><strong style=\"white-space:pre-wrap;\">How You Will Make an Impact</strong></b></p><ul data-pattern=\"discCircleSquare\" data-depth=\"1\" style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;margin:8px 0px;line-height:1.6;padding:0px 0px 0px 32px;list-style-type:disc;\"><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Oversee the strategy and handling of complex cases that tend to involve multiple claims, parties, and schemes.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Direct projects and initiatives related specifically to major case and provider fraud initiatives.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Ensure leaders drive investigations that are conducted in a thorough, efficient manner that is completely compliant with laws, regulations, and ethics.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Monitor trends with lawsuit filings for FPM and Injury.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Manage defense spend per matter, taking specific venue nuances into consideration.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Lead and develop a collaborative team where everyone is engaged, empowered to express their ideas, and motivated to drive the organization forward through challenges.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Control inventory by ensuring proactive and efficient investigations that align with the established procedures.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Monitor results ensuring that medical bills are properly adjudicated and paid timely.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Engage in coaching appropriate behaviors with leaders, ensuring they are coaching effectively to drive performance, quality, and effective claim handling tactics.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Drive employee development, including both technical and leadership development.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Facilitate training and awareness sessions with claims teams to further develop their fraud awareness skills.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Ensure leaders monitor overall case quality through Quality Assurance reviews, Targeted Audits, and Closed File Reviews.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Ensure that customer claims are resolved in a professional and timely manner.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Maintain an environment where the importance of employee empowerment does not get lost in the day-to-day operations of running a claims department.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Recruits, retains and develops a highly motivated and accountable team of experienced and developing claim professionals</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Lead teams investigating claims </span><span style=\"color:rgb(0,0,0);font-size:10.5pt;white-space:pre-wrap;\">that are geographically dispersed across the country</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Drive pace within the team, resulting in best-in-class LAE while maintaining high employee satisfaction.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Help establish and drive adherence to processes to drive technical claim handling, resulting in best-in-class loss performance while maintaining high customer satisfaction</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Use internal controls associated with claims payments and quality of file handling</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Advocates for talent and builds capabilities to ensure strong leadership and technical talent bench strength</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);font-size:11pt;white-space:pre-wrap;\">Provides expertise to the team in reviewing, researching, investigating, negotiating, processing and adjusting claims</span></li></ul><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;text-align:left;\"><br><b><strong style=\"white-space:pre-wrap;\">What You Will Need to Succeed</strong></b></p><ul data-pattern=\"discCircleSquare\" data-depth=\"1\" style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;margin:8px 0px;line-height:1.6;padding:0px 0px 0px 32px;list-style-type:disc;\"><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">5+ years of progressive leadership experience in P&amp;C Insurance, specifically overseeing First Party Medical (PIP/No-Fault) claims and/or Medical related Special Investigative Units (SIU).</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Deep subject matter expertise in medical provider fraud, upcoding, unbundling, and complex multi-party clinic schemes.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Extensive experience managing medical claims and fraud investigations in New York, Michigan, New Jersey, and Florida (highly preferred).</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Proven ability to manage and balance highly technical metrics, including cycle times, RTQA results, and closure rates.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Ability to identify broader fraud trends across organizations and build actionable defense strategies.</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Bachelor’s degree or equivalent experience required</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Strong technical understanding of liability and casualty principles</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Experience managing complex, high exposure claim investigations through closure</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Ability to build collaborative working relationships</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Communicates and collaborates effectively in a virtual environment</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">High sense of professionalism while remaining empathetic</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Curious in nature</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Great attention to detail</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Self-starter and ability to work independently and effectively prioritize work</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Ability to handle ambiguity and quickly adapt when changes occur</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Strong written and oral communication skills</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Ability to approach problems with an open mind</span></li><li style=\"color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;\"><span style=\"color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:11pt;white-space:pre-wrap;\">Ability to obtain and maintain insurance licenses in several states (including Texas) within three months</span></li></ul><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;text-align:left;\"><br></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;text-align:left;\"><br><span style=\"color:rgb(29,28,29);background-color:rgb(255,255,255);white-space:pre-wrap;\">As part of Root's interview process, we kindly ask that all candidates be on camera for virtual interviews. This helps us create a more personal and engaging experience for both you and our interviewers. Being on camera is a standard requirement for our process and part of how we assess fit and communication style, so we do require it to move forward with any applicant's candidacy. If you have any concerns, feel free to let us know once you are contacted. We’re happy to talk it through.</span></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;\"><span style=\"color:rgb(29,28,29);white-space:pre-wrap;\">Please see our Privacy Notice available&nbsp;</span><a href=\"http://inc.joinroot.com/california-job-applicant-privacy-notice/\" target=\"_blank\" class=\"css-173makr-linkStyle\" style=\"color:rgb(30,74,169);cursor:pointer;\"><span style=\"color:rgb(29,28,29);white-space:pre-wrap;\">HERE</span></a><span style=\"color:rgb(29,28,29);white-space:pre-wrap;\">&nbsp;for more information on how we process your personal data.</span></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;\"><br></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;\"><span style=\"color:rgb(29,28,29);white-space:pre-wrap;\">Consistent with the Americans with Disabilities Act (ADA) and the Civil Rights Act of 1964, it is the policy of Root to provide reasonable accommodation when requested by a qualified applicant or candidate with a disability, unless such accommodation would cause an undue hardship for Root. The policy regarding requests for reasonable accommodation applies to all aspects of the hiring process. If reasonable accommodation is needed, please contact [email protected]</span></p>",
      "company": "<meta><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;text-align:justify;\"><span style=\"color:rgb(29,28,29);background-color:rgb(255,255,255);white-space:pre-wrap;\">Root was founded on the belief that car insurance is broken, and we set out to change it. We’re harnessing the power of technology to revolutionize this archaic, complicated industry. Using machine learning and mobile telematic platforms, we’ve built one of the most innovative insurtech companies in the world. </span></p><p style=\"font-family:&quot;Basel Grotesk&quot;,Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;text-align:justify;\"><br></p>"
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