Senior Investigator - Remote in Indiana - 2269064

Primary Care Plus; Indianapolis (IN); Remote; USD 59,000 - 117,000; Full time

Job summary

A leading healthcare organization is seeking a Senior Investigator to identify and prevent healthcare fraud, waste, and abuse. This role involves analyzing claims data, conducting investigations, and collaborating with regulatory bodies. Candidates must reside in Indiana and have relevant experience in fraud investigation. The position offers the flexibility to telecommute and includes a comprehensive benefits package.

Benefits

Paid Time Off

Medical Plan Options

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Qualifications

• 2+ years of experience in healthcare fraud, waste and abuse (FWA).
• Ability to travel up to 25%.

Responsibilities

• Investigate complex cases of fraud, waste, and abuse.
• Develop and deploy effective investigative strategies.
• Communicate findings and maintain accurate case information.

Skills

Healthcare Fraud Investigation

Data Analysis

Communication

Education

Bachelor’s Degree

Associate’s Degree

Tools

Microsoft Excel

Microsoft Word

Job description

Senior Investigator - Remote in Indiana - 2269064

Senior Investigator - Remote in Indiana - 2269064

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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 start Caring. 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 to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.

If you reside within the state of Indiana, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

Responsibilities

Primary Responsibilities:

• Assess complaints of alleged misconduct received within the Company
• Investigate medium to highly 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 later
• Communicate effectively, to include written and verbal forms of communication
• Develop goals and objectives, track progress and adapt to changing priorities
• 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 work-groups or regulatory meetings
  
  

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.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits
  
  

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

• Bachelor’s Degree (or higher) OR Associate’s Degree AND 2+ years of healthcare related employment
• 2+ years of experience in healthcare fraud, waste and abuse (FWA)
• 2+ years of experience with state or federal regulatory FWA requirements
• 2+ years of experience with analyzing data to identify fraud, waste and abuse trends
• 2+ years of experience in Microsoft Excel
• 2+ years of experience in Microsoft Word
• Ability to travel up to 25%
• Must participate in legal proceedings, arbitration, and depositions at the direction of management
• Reside in Indiana and be within a comfortable commutable distance to Indianapolis, IN
  
  

Preferred Qualifications

• Demonstrated intermediate level of knowledge in health care policies, procedures, and documentation standards or 2-5 years of experience
• Demonstrated intermediate level of skills in developing investigative strategies or 2-5 years of experience
• Specialized knowledge/training in healthcare FWA investigations
• Active affiliations: 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)
• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
  
  

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

#RPO #YELLOW

External Candidate Application

Internal Employee Application

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other, Information Technology, and Management

• Industries

  Hospitals and Health Care

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