Manager of Investigations - Remote

UnitedHealthcare; Richardson (TX); Remote; USD 92,000 - 164,000; Full time

Job summary

UnitedHealthcare is seeking a Manager of Investigations to oversee investigators focused on healthcare fraud, waste and abuse, with remote work options across the U.S. The role emphasizes compliance with the Fraud, Waste and Abuse Program and leadership responsibilities.

You will guide investigative strategies, ensure accurate case documentation, participate in settlements, analyze data, and collaborate with state/federal partners while supporting SIU leadership.

Qualifications

• Associate’s degree or higher.
• 5+ years of health care FWA investigations experience.
• 5+ years of experience with state/federal laws and regulations pertaining to healthcare FWA.
• 5+ years of experience in analyzing data to identify fraud, waste and abuse trends.
• Advanced proficiency in Microsoft Excel and Word.
• Ability to travel up to 25%.

Responsibilities

• Managerial oversight of all types of FWA cases, across all complexity levels.
• Ensure compliance with the UnitedHealthcare Fraud, Waste and Abuse Program.
• Communicate effectively in written and verbal forms.
• Provide guidance to investigators on effective investigative strategies.
• Maintain accurate, current case information in the SIU case tracking system.
• Participate in settlement negotiations and prepare investigative materials.
• Collect, analyze, and interpret data related to FWA.
• Ensure compliance with applicable federal/state regulations or contractual obligations.
• Supervise a team and coordinate with SIU leadership.

Skills

FWA investigations

Data analysis

Excel & Word

Communication skills

Travel readiness

Education

Associate degree or higher

Tools

Microsoft Excel

Microsoft Word

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Manager of Investigations - Remote (2390387)

Manager of Investigations - Remote - 2390387

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

The Manager of Investigations is responsible for the direct oversight of investigators whose primary roles are the identification, investigation and prevention of healthcare fraud, waste and abuse.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Managerial oversight of all types of fraud, waste and abuse cases, to include all levels of complexity
• Ensure compliance with the UnitedHealthcare (UHC) Fraud, Waste and Abuse Program
• Ability to communicate effectively, including written and verbal forms of communication
• Provide guidance to investigators on effective and efficient investigative strategies
• Ensure investigators maintain accurate, current and thorough case information in the Special Investigations Unit’s (SIU’s) case tracking system
• 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
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Ensure investigators compliance 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
• Ability to supervise a team
• Must participate in legal proceedings, arbitrations, depositions, etc.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Associate’s degree or above
• 5+ years of experience in health care fraud, waste and abuse (FWA) investigations/audit
• 5+ years of experience with state/federal laws and regulations pertaining to healthcare FWA
• 5+ years of experience in analyzing data to identify fraud, waste and abuse trends
• Advanced level of proficiency in Microsoft Excel and Word
• Ability to travel up to 25%

Preferred Qualifications:

• 2+ years of direct supervisory experience
• Active affiliation with National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Professional Coder (CPC)
• Specialized knowledge/training in healthcare FWA investigations

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline:

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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