Senior Investigator - Remote in Michigan

UnitedHealthcare; Grand Rapids (MI); Remote; USD 59,000 - 117,000; Full time

Job summary

UnitedHealthcare is looking for a Senior Investigator to identify and prevent healthcare fraud, waste, and abuse. This remote role in Michigan involves working with data to detect fraudulent activity and conducting field investigations. Ideal candidates have experience in healthcare investigations and communication skills. Join a leading health organization to make a significant impact.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Qualifications

• 2+ years of experience in health care fraud, waste and abuse (FWA).
• 2+ years of experience in state or federal regulatory FWA requirements.
• Experience analyzing data to identify fraud trends.

Responsibilities

• Investigate complex cases of fraud, waste and abuse.
• Communicate findings effectively to stakeholders.
• Develop investigative strategies for each case.

Skills

Analytical thinking

Communication

Problem-solving

Education

Bachelor’s Degree

Associates Degree with 2+ years of equivalent work experience

Tools

Microsoft Excel

Microsoft Word

Job description

Senior Investigator - Remote in Michigan

Join to apply for the Senior Investigator - Remote in Michigan role at UnitedHealthcare

Senior Investigator - Remote in Michigan

13 hours ago Be among the first 25 applicants

Join to apply for the Senior Investigator - Remote in Michigan role at UnitedHealthcare

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.

You’ll enjoy the flexibility to telecommute* from anywhere within Michigan as you take on some tough challenges.

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 workgroups or regulatory meetings
  
  

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 Associates Degree with 2+ years of equivalent work experience and healthcare related employment
• 2+ years of experience in health care fraud, waste and abuse (FWA)
• 2+ years of experience in state or federal regulatory FWA requirements
• 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 locally (in-state) up to 25% of the time, as needed
• Ability to participate in legal proceedings, arbitration and depositions at the direction of management
• Access to reliable transportation and valid US driver’s license
  
  

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
• National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• 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 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

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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