• Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes • Monitor business processes and systems to assure integrity and compliance in billing and claims payment • Lead a team appropriately investigate all possible fraud, waste and abuse referrals • Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis • Attend state/federal meetings as required by specific contracts • Review pre-payment cases with appropriate parties for the purposes of developing resolution strategies • Prepare and distribute monthly and quarterly saving reports • Participate in Appeals Committee, work groups and interdepartmental meetings