Senior 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 Senior Investigator is responsible for identification, investigation, and prevention of healthcare fraud, waste, and abuse. You will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. This role involves conducting investigations, which may include field work to perform interviews and obtain records or other relevant documentation. You will manage a high volume of cases, triaging, investigating, and resolving instances of healthcare fraud and abusive conduct. Responsibilities include audits, claims data analysis, conducting investigations, and compiling findings. You will enjoy the flexibility to telecommute* from anywhere within the U.S.

Responsibilities

• Assess complaints of alleged misconduct received within the Company
• Investigate medium to high complexity 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 with 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, including attendance at workgroups or regulatory meetings
• Communicate effectively, both in written and verbal forms
• 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
• 2+ years of experience in fraud, waste, and abuse (FWA) investigations/audit
• 2+ years of experience with state/federal laws and regulations pertaining to healthcare FWA
• 2+ years of experience in analyzing data to identify fraud, waste, and abuse trends
• Intermediate level of proficiency in Microsoft Excel and Word
• Ability to travel up to 25% and valid US driver's license

Preferred Qualifications

• Specialized 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)
• Experience with statistical analysis

All telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Benefits

• Competitive base pay
• Paid Time Off (accrued from first pay period) plus 8 paid holidays
• Medical plan options, including Health Spending Account or Health Savings Account
• Dental, Vision, Life & AD&D Insurance
• Short-term and Long-Term Disability coverage
• 401(k) Savings Plan
• Employee Stock Purchase Plan
• Education reimbursement
• Employee discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary benefits (pet insurance, legal insurance, LTC Insurance, etc.)

Pay

The salary for this role will range from $60,200 to $107,400 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.