Senior Investigator

UnitedHealth Group; Houston (TX); On-site; USD 60,000 - 107,000; Full time

Benefits offered by this job

Paid Time Off

Medical plan options

Dental, Vision, Life & AD&D

Job summary

UnitedHealth Group is seeking a Senior Investigator to identify and prevent healthcare fraud, waste, and abuse. You will use claims data and guidelines to identify aberrant billing patterns and conduct investigations, including fieldwork and records requests. This remote role supports U.S.

operations with EST/CST hours and potential travel. Responsibilities include assessing complaints, leading complex investigations, maintaining detailed case information in SIU systems, and reporting findings

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.
• Intermediate level of proficiency in Microsoft Excel and Word.
• Ability to travel up to 25% and valid US driver's license.

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.

Skills

FWA investigations

Data analysis

Excel

Word

Travel 25%

NHCAA affiliations

AHFI

CFE

CPC

MLT

Statistical Analysis

Education

Associate's degree

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 startCaring. Connecting. Growing together.

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

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Preference for those residing in EST or CST zones.

Flexibility required to work EST or CST hours.

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.

• 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 directions 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
• 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 Fraud Examiner (CFE)
• 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.

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.

#RPO #GREEN