Senior Investigator

About the role

The Senior Investigator is responsible for identifying, investigating, and preventing healthcare fraud, waste, and abuse. This role involves assessing complaints, developing and deploying investigative strategies, collecting and securing evidence, and reporting findings.

Responsibilities

• Assess complaints of alleged misconduct received within the Company
• Investigate medium to high 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
• 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
• 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 50%
• Access to reliable transportation, and valid US driver's license
• Reside in the state of New Mexico

Qualifications

• Specialized knowledge/training in healthcare FWA investigations
• Active affiliations with the National Health Care Anti-Fraud Association (NHCAA)
• Certified Health Care Fraud Investigator (CHFI)
• Certified Fraud Examiner (CFE)
• Certified Professional Coder (CPC)
• Statistical Analysis

Benefits

UnitedHealth Group offers a comprehensive benefits package including:

• Competitive base pay
• Full and comprehensive benefit program
• Performance rewards
• Management team who demonstrates commitment to your success
• Paid time off
• Medical plan options
• Dental, vision, life & AD&D insurance
• Short-term and long-term disability coverage
• 401(k) savings plan
• Employee stock purchase plan
• Education reimbursement
• Employee assistance program
• Employee referral bonus program
• Voluntary benefits

Pay

The salary for this role ranges from $60,200 to $107,400 annually based on full-time employment. UnitedHealth Group complies with all minimum wage laws as applicable.

Schedule

Monday-Friday 8-4:30 CST