Senior Investigator

Taleo; Houston (TX); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options

Dental, Vision, Life & AD&D Insurance

Short-term disability

Long-Term Disability

401(k) Savings Plan

Employee Stock Purchase Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Employee Referral Bonus Program

Voluntary Benefits

Job summary

UnitedHealth Group is seeking a Senior Investigator to identify, investigate, and prevent healthcare fraud, waste, and abuse. The role uses claims data and guidelines to uncover aberrant billing patterns and requires fieldwork for records and interviews.

The Senior Investigator handles high‑volume case loads, conducts audits and data analysis, and compiles findings. Telecommuting is allowed from anywhere in the U.S. with occasional travel up to 25%.

Qualifications

• 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.

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 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 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.

Skills

Fraud investigations

Data analysis

MS Excel

Tools

Microsoft Word

Job description

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

Job Description - Senior Investigator (2382877)

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 startCaring. Connecting. Growing together.

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

The challenge for you will be the high volume of cases on your plate at one time. You will be part of a team responsible for triaging, investigating and resolving instances of healthcare fraud and/or abusive conduct. You will spend your time doing audits, claims data analysis, conducting investigations and putting together your findings.

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

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

What are the reasons to consider working for UnitedHealth Group? Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability 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.)

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:

• 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 Professional Coder (CPC)
• Medical Laboratory Technician (MLT)
• Statistical Analysis

*All Telecommuters 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 $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

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.

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.

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.