Investigator

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable.

About the Role

The Investigator is responsible for identification, investigation, and prevention of healthcare fraud, waste, and abuse. The Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The role involves conducting investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.

Office location: Warwick, RI. Hybrid role with expectation to work out of the Warwick, RI office approximately 3-4 times per week. 25-50% of expected travel within Rhode Island. If you reside in the state of Rhode Island, you will have the flexibility to hybrid-remote.

Responsibilities

• Assess complaints of alleged misconduct received within the Company
• Investigate low to medium complex cases of fraud, waste, and abuse
• Detect fraudulent activity by members, providers, employees, and other parties against the Company
• Develop and deploy the most effective and efficient investigative strategy for each investigation
• Maintain accurate, current, and thorough case information in the Special Investigations Unit's (SIU's) case tracking system
• Collect and secure documentation or evidence and prepare summaries of the findings
• Participate in settlement negotiations and/or produce investigative materials in support of the latter
• Collect, collate, analyze, and interpret data relating to fraud, waste, and abuse referrals
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Report suspected fraud, waste, and abuse to appropriate federal or state government regulators
• Comply with goals, policies, procedures, and strategic plans as delegated by SIU leadership
• Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings
• Communicate effectively, including written and verbal forms of communication
• Develop goals and objectives, track progress, and adapt to changing priorities
• Participate in legal proceedings, arbitration, and depositions at the direction of management

Requirements

• Associate's degree or above
• Intermediate level of proficiency in Microsoft Excel and Word
• Reside within a commutable distance to Warwick, RI
• Ability to travel up to 50%, access to reliable transportation, and valid US driver's license

Preferred Qualifications

• Experience in health care fraud, waste, and abuse (FWA) investigations/audit
• Experience with state/federal laws and regulations pertaining to healthcare FWA
• Experience in analyzing data to identify fraud, waste, and abuse trends
• Knowledge/training in healthcare FWA investigations
• Active affiliations with the National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• Certified Professional Coder (CPC)
• Medical Laboratory Technician (MLT)
• Statistical Analysis

Benefits

In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

Pay

The salary for this role will range from $49,700 to $88,800 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.