Investigator - National Remote

UnitedHealthcare; Minnetonka (MN); Remote; USD 49,000 - 97,000; Full time

Job summary

A leading healthcare organization is seeking an Investigator to identify and prevent healthcare fraud, waste, and abuse. This role involves analyzing claims data, conducting investigations, and ensuring compliance with regulations. The position offers flexibility to telecommute and includes competitive pay and comprehensive benefits.

Benefits

Paid Time Off

Medical, Dental, Vision Insurance

401(k)

Education Reimbursement

Employee Discounts

Referral Bonuses

Qualifications

• Bachelor’s Degree or Associate's Degree with 2+ years healthcare experience.
• Ability to participate in legal proceedings and travel up to 25%.

Responsibilities

• Investigate low to medium complex cases of fraud, waste, and abuse.
• Develop and deploy effective investigative strategies for each case.
• Collaborate with state/federal partners and attend relevant meetings.

Skills

Data Analysis

Communication

Education

Bachelor’s Degree

Associate's Degree

Tools

Microsoft Excel

Microsoft Word

Job description

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. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

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

Travel: Up to 25%

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

1. Assess complaints of alleged misconduct received within the company
2. Investigate low to medium complex cases of fraud, waste, and abuse
3. Detect fraudulent activity by members, providers, employees, and other parties against the company
4. Develop and deploy effective investigative strategies for each case
5. Maintain accurate case information in the SIU’s case tracking system
6. Collect and secure documentation or evidence and prepare summaries of findings
7. Participate in settlement negotiations and produce investigative materials
8. Analyze data relating to fraud, waste, and abuse referrals
9. Ensure compliance with federal, state, and contractual obligations
10. Report suspected fraud, waste, and abuse to regulators
11. Follow policies, procedures, and strategic plans as delegated by SIU leadership
12. Collaborate with state/federal partners and attend relevant meetings
13. Communicate effectively in written and verbal forms
14. Develop goals, track progress, and adapt to priorities

Why Work for UnitedHealth Group? Competitive pay, comprehensive benefits, performance rewards, and a management team committed to your success. Offerings include:

• Paid Time Off and 8 Paid Holidays
• Medical, Dental, Vision, Life & AD&D Insurance, Disability coverage
• 401(k), Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts and Assistance Programs
• Referral Bonuses and Voluntary Benefits
• More info: http://uhg.hr/uhgbenefits

We reward performance in a challenging environment with clear development pathways.

Required Qualifications

• Bachelor’s Degree or higher, or Associate's Degree with 2+ years healthcare experience
• Proficiency in Microsoft Excel and Word
• Specify your minimum salary and total compensation expectations
• Ability to participate in legal proceedings and travel up to 25%
• Reliable transportation and valid US driver’s license

Preferred Qualifications

• Knowledge of healthcare policies, procedures, and documentation standards
• Understanding of federal/state fraud, waste, and abuse regulations
• Skills in data analysis for fraud trend identification
• Experience in developing investigative strategies
• Specialized training or certifications in healthcare FWA investigations
• Membership in NHCAA, AHFI, CFE, CPC, MLT
• Telecommuting adherence to company policy

The salary range is $49,300 to $96,400 annually, based on full-time employment and various factors. Benefits include a comprehensive package, incentives, and stock options. We consider qualified applicants regardless of arrest or conviction records per local laws.

Application deadline: Minimum 2 days posting or until sufficient candidates are found. The job posting may be removed early due to volume.

Our mission is to help people live healthier lives and improve the health system for everyone, addressing disparities and promoting equity. We are an EEOC employer and drug-free workplace. Candidates must pass a drug test before employment.