Manager, Special Investigations Unit

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.

At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

Join Judi Rx in advancing pharmacy benefit integrity through disciplined investigations, regulatory expertise, and data-driven action. 

Location: Remote

Role Overview 

The Manager, SIU - Pharmacy Investigations is a strategic and hands-on leader with required prior pharmacy investigation experience who is responsible for the effective operation, oversight, and continuous improvement of the pharmacy Fraud, Waste, and Abuse (FWA) investigations program. This role leads complex pharmacy investigations, develops a high-performing team, strengthens investigative standards, and ensures matters are handled consistently, objectively, and in accordance with applicable requirements. The Manager serves as a trusted advisor to leadership, clients, Compliance, Legal, Audit, Network, Clinical, Data, and other business partners while maintaining the independence and confidentiality expected of an SIU function. 

What You Will Lead 

• Lead the pharmacy SIU investigations program, including intake, triage, case assignment, investigative strategy, documentation, escalation, resolution, and closure. 

• Build and maintain a risk-based investigative framework aligned with applicable federal and state requirements, contractual obligations, accreditation standards, client expectations, and recognized industry practices. 

• Direct complex investigations involving suspected pharmacy fraud, waste, or abuse, including schemes identified through referrals, analytics, audits, complaints, hotline reports, or other credible sources. 

• Ensure investigative plans are thorough, impartial, timely, and supported by clear evidence, defensible findings, and complete case documentation. 

• Use claims data, trend analysis, public records, interviews, supporting documentation, and investigative tools to identify patterns, relationships, emerging schemes, and potential program risk.