Senior Investigator

UnitedHealthcare; 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

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Referral Bonus Program

Voluntary Benefits

Job summary

UnitedHealthcare, part of UnitedHealth Group, is seeking a Senior Investigator to identify, investigate, and prevent healthcare fraud, waste, and abuse. You will use claims data and regulations to guide actions, potentially performing fieldwork and interviews. The role offers telecommuting from anywhere in the U.S.

with a preference for EST or CST hours. The position emphasizes analyzing cases, developing investigative strategies, and maintaining thorough case records while ensuring regulatory

Qualifications

• 2+ years of experience in fraud, waste and abuse (FWA) investigations and 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.

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) 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 regulators.
• Collaborate with state/federal partners and attend workgroups or regulatory meetings.

Skills

FWA investigations

Regulatory compliance

Data analysis

Travel up to 25%

Tools

Microsoft Excel

Microsoft Word

Job description

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

Job Description - Senior Investigator (2384260)

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.

TheSeniorInvestigatoris responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. TheSeniorInvestigatorwill utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. TheSeniorInvestigatoris 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:

• A ssess 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.)

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.

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.