Senior Manager Internal Audit
Current• Responsible for assisting senior management and providing thought leadership in establishing the short and long-term fraud strategy for VSP Global (US, Canada, UK and Australia).• Subject Matter Expert for matters relating to Fraud Waste and Abuse (FWA) on various corporate committees and requests for information from various corporate departments. • Responsible for facilitating the VSP Global Fraud Task force that involves all four lines of business. This Task force is charged to work together to combat FWA.• Responsible for reviewing and analyzing utilization, billing patterns, and submissions for irregularities that warrant further investigation of potential fraud involving providers, employees, patients and vendors.• Responsible for recovering assets and negotiating settlements for cases involving restitution and recovery. Since joining the SIU, responsible for helping increase the recoveries eightfold (8 to 1).• Responsible for conducting critical and in-depth professional and clinical reviews on every case to be approved by the Senior Director of Internal Audit, Deputy General Counsel and Optometry Director.• Testify as an expert witness at depositions, provider peer reviews, arbitrations and court trials.• Manage and review the work of direct reports including analysis of claims and case files in order to obtain information and supporting evidence for investigations and trials.• Supervise and oversee the work of up to seven fraud investigators and claims auditors.• Work with outside consultants, client auditors, government agencies and law enforcement.• Responsible for the training, coaching, development and mentoring of SIU and Claims staff.• Responsible for preparing and providing information to senior management that is presented at the quarterly Audit Committee.
