Senior Investigator - FWA & SIU (Remote KY)

UnitedHealth Group; Frankfort (KY); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Telecommuter Policy

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking an experienced investigator to analyze data and determine the validity of fraud, waste, and abuse issues within KY. You will collaborate with clinical coding and legal teams, compiling thorough investigation summaries for clients and regulators.

The role offers remote work within Kentucky with up to 25% travel for on-site visits, plus a comprehensive benefits package and clear opportunities for career development within a large health system.

Qualifications

• High School Diploma/GED is required.
• 5+ years of experience in FWA/SIU or fraud investigations.
• 2+ years of experience in the health insurance claims industry.
• 2+ years with law enforcement/legal entities or 3+ years in investigations.
• 1+ years knowledge of behavioral health codes and service delivery.
• Proficiency in Excel (pivot tables/macros) and Word.

Responsibilities

• Gather and analyze data to determine behavior and understand provider/scheme at issue.
• Use case tracking systems to ensure compliance and auditability.
• Collaborate with clinical coding consultant to apply coding guidelines for validity.
• Gather facts to articulate behavior via Investigation Summary and compliance package; communicate rationale to clients and regulators.
• Coordinate with external sources to identify patterns related to FWA and submit TIP as needed.
• Conduct member and provider interviews and review medical documentation as needed.
• Communicate with legal, law enforcement, clients and business partners as needed.

Education

High School Diploma/GED

Tools

Excel

Word

Job description

UnitedHealth Group is seeking an experienced investigator to analyze data and determine the validity of fraud, waste, and abuse issues within KY. You will collaborate with clinical coding and legal teams, compiling thorough investigation summaries for clients and regulators.

The role offers remote work within Kentucky with up to 25% travel for on-site visits, plus a comprehensive benefits package and clear opportunities for career development within a large health system.