Senior Investigator - Rhode Island

Primary 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
• 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
• Must participate in legal proceedings, arbitration, and depositions at the direction of management

Required Qualifications

• 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
• Demonstrated intermediate level of proficiency in Microsoft Excel and Word
• Ability to travel up to 50%
• Reside within a commutable distance to Warwick, RI
• Access to reliable transportation 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)
• Certified Health Care Fraud Investigator (AHFI)
• Certified Professional Coder (CPC)
• Medical Laboratory Technician (MLT)
• Statistical Analysis

Benefits

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.

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).

The salary for this role will range from $60,200 - $107,400 annually based on full-time employment.

We comply with all minimum wage laws as applicable.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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