Director, Program Integrity & SIU Investigations

Who We Are

At Lucet, we are industry leaders in behavioral health, dedicated to helping people live healthy, balanced lives. Our purpose is to advocate for and improve the overall well-being of those we serve, through balanced treatment of the mind and body.

When you join Lucet, you become a valued member of our team, serving more than 15 million people across the U.S. Our employees have a passion for helping others - and it shows. From entry-level employees to senior leaders, we are inspired by our members, putting them first in everything we do. From day one, you'll see firsthand the impact you have on our members, knowing you can make a true difference in their lives.

Why Join our Team

At Lucet, we’re committed to creating a workplace where top talent thrives both personally and professionally. We offer a dynamic, mission-driven environment where your work has real impact, your unique background and experience are valued, and no two days are alike. If you’re passionate about meaningful work and delivering impactful results, we encourage you to apply!

We support our team with a competitive compensation and benefits package, including:

• Annual compensation between $110,000 - $135,000, PLUS an annual performance-based, discretionary incentive.
  
  • *Compensation is dependent on non-discriminatory factors including but not limited to an applicant's skills, education/degrees, certifications, prior experience, market data, and other relevant factors.
• Comprehensive health benefit options: Medical, dental, and vision coverage
• 401(k) with competitive employer match
• Company-paid life and disability insurance
• Paid parental leave and wellbeing incentives
• Generous paid time off, including volunteer time
• Flexible spending accounts for healthcare and dependent care
• Professional development opportunities and tuition reimbursement
• Remote work flexibility (role-dependent)
• Opportunity for meaningful growth, both personally and professionally, where your unique background and experience is welcomed and valued.

At Lucet, your work will directly support our mission to improve behavioral, physical, and social health—one member at a time.

What You Will Do - Essential Functions

The Director of Program Integrity provides strategic direction and oversight of the organizational fraud, waste and abuse (FWA) program encompassing conducting routine and targeted claims audits, data analyses, and investigations to detect, prevent, and remediate FWA related to behavioral health, direct medical care, and other healthcare services. This role is responsible for the oversight of the FWA program through the assurance of accurate medical coding, claims processing, compliance with documentation and regulatory requirements, appropriate service utilization, effective overpayment recovery, and prepayment prevention. 

• Strategic Leadership and FWA Oversight:
  • Lead FWA strategy and program integrity efforts through audits, investigations, data analysis, training, and implementation of anti-fraud initiatives that drive compliance and financial recovery.
    Advise leadership on claims risk, regulatory trends, and recovery opportunities while maintaining strong client relationships and supporting team development and certifications.
• Cross-Functional and External Collaboration
  • Partner with internal teams across operations, legal, clinical, IT, and analytics to support audits, committees, and initiatives that strengthen fraud detection and oversight.
  • Serve as the primary liaison to health plans, regulators, law enforcement, and auditors, overseeing external audit responses, regulatory requests, and executive presentations.
• Operational Excellence and Innovation
  • Oversee and continuously enhance the FWA Plan, policies, procedures, reporting, and KPIs to ensure accuracy, transparency, and operational effectiveness.
  • Drive innovation by leading training programs, adopting new tools and investigative methods, and managing third-party vendor and partner relationships.
• Team Leadership & Development
  • Mentor and lead a high‑performing team by fostering a culture aligned with Lucet’s values, emphasizing accountability, continuous development, and adaptability to change.
    Provide hands‑on leadership through cross‑functional collaboration, training, and ongoing support to equip team members with best practices, tools, and techniques to achieve shared enterprise‑wide goals.

Who You Are

• Required Qualifications
  • Bachelor’s degree in healthcare, public administration, or related field.
  • 3+ years of management experience that clearly demonstrates leadership.
  • 7+ years of experience in healthcare claims auditing, investigations, program integrity, healthcare compliance, or a related area.
  • 7+ year’s healthcare/managed care claims, reimbursement, contracting and/or analytics experience.
  • Experience in developing and implementing audit and/or anti-fraud plans, policies and procedures, training materials, workflow diagrams, standard operating procedures or other documentation.
  • Proficient with all healthcare coding (CPT4, HCPCS, DRG, ICD-9, ICD-10 & Revenue Codes)
  • Experience and familiarity with data analysis and data mining for purposes of fraud detection
  • Demonstrated experience in successful overpayment recovery.
  • Ability to pass background check upon hire and throughout employment to include criminal felony & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree obtained), civil upper and lower search, 7-year employment report, federal criminal search, statewide criminal search, widescreen plus national criminal search, health care sanctions-state med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist), and a 10-Panel Drug Screen. 
• Someone who embodies our values by:
  • Serving everyone with compassion and leading with empathy.
  • Stepping up and creating value by taking charge and acting when there is an opportunity.
  • Adapting in a changing world by recognizing our responsibility to be agile and respond quickly.
  • Nurturing growth and belonging by respecting and celebrating everyone for who they are.
• Competencies
  • Clearly and professionally conveys complex information in both written and verbal form to internal and external stakeholders.
  • Analyzes complex information, identifies trends, and draws well-supported conclusions.
  • Ability to manage sensitive issues with discretion and professionalism.
  • Builds trust-based and collaborative relationships across teams and with external partners (health plans, regulators).
  • Adapts quickly to shifting priorities, regulatory changes, or emerging fraud trends.
• Working Conditions:

  • High-speed internet service (cable or fiber optic) with minimum download Speed of 20 Mbps, Upload Speed of 5 Mbps, and Maximum Latency of 100 milliseconds (must be installed before starting) required.

  • Frequent use of computer and phone systems

  • Must be able to constantly remain in a stationary, sitting position, communicate and exchange information with others, inspect information, perform repetitive motions with arms and fingers, interpret data, problem solve, make decisions, organize and plan, and maintain a positive and professional attitude in all situations.

  • Work is performed from home with company-provided equipment. Sitting for long periods of time is expected and use of fingers and hands for typing is necessary.

  • A quiet workspace with minimal background noise for calls.

We encourage applicants from a variety of backgrounds and experiences to apply, especially those who can demonstrate how their unique qualifications and skills align with the requirements of this role and support our mission to improve whole-person health.

This position will accept and review new applications and resumes no less than 5 business days after the original posting date and may remain open an extended period of time with no set end date based on the level of interest.