Senior Investigator - Remote in Ohio - 2287486

UnitedHealth Group; Columbus (OH); Hybrid; Confidential; Full time

Job summary

UnitedHealth Group is seeking a Senior Investigator to combat healthcare fraud, waste, and abuse. This role involves analyzing claims data, conducting investigations, and ensuring compliance with regulations. The ideal candidate will have a Bachelor’s Degree and experience in healthcare FWA, with strong analytical and communication skills.

Benefits

Paid Time Off and Holidays

Medical, Dental, Vision, Life & AD&D Insurance

401(k) and Employee Stock Purchase Plan

Education Reimbursement

Employee Discounts and Assistance Programs

Referral Bonuses

Qualifications

• 2+ years in healthcare fraud, waste, and abuse (FWA).
• Experience with federal/state FWA requirements.
• Ability to travel locally up to 25%.

Responsibilities

• Investigate complex cases of fraud, waste, and abuse.
• Develop and deploy effective investigative strategies.
• Communicate findings and report suspected fraud.

Skills

Data Analysis

Communication

Investigation

Education

Bachelor’s Degree

Associate’s Degree with 2+ years of healthcare-related experience

Tools

Microsoft Excel

Microsoft Word

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 start

Caring. Connecting. Growing together.

Position: Senior Investigator

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. They will conduct investigations, which may include field work such as interviews and obtaining records or relevant documentation.

Schedule:

Monday-Friday 8:00am - 4:30pm EST

You’ll enjoy the flexibility to telecommute* from anywhere within Ohio 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 effective investigative strategies for each case
• Maintain accurate case information in the SIU’s case tracking system
• Collect and secure documentation or evidence and prepare summaries of findings
• Participate in settlement negotiations and support investigations with materials
• Communicate effectively in written and verbal forms
• Develop goals, track progress, and adapt to changing priorities
• Analyze data related to fraud, waste, and abuse referrals
• Ensure compliance with federal/state regulations and contractual obligations
• Report suspected fraud to appropriate authorities
• Collaborate with state/federal partners as needed

Why work for UnitedHealth Group?

Competitive pay, comprehensive benefits, performance rewards, and a supportive management team. Benefits include:

• Paid Time Off and Holidays
• Medical, Dental, Vision, Life & AD&D Insurance, Disability coverage
• 401(k), Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts and Assistance Programs
• Referral Bonuses and Voluntary Benefits

More details at: http://uhg.hr/uhgbenefits

Required Qualifications:

• Bachelor’s Degree or Associate’s Degree with 2+ years of healthcare-related experience
• 2+ years in healthcare fraud, waste, and abuse (FWA)
• Experience with federal/state FWA requirements and data analysis
• Proficiency in Microsoft Excel and Word
• Ability to travel locally up to 25%
• Legal ability to participate in legal proceedings and a valid US driver’s license

Preferred Qualifications:

• Knowledge of healthcare policies and investigative strategies
• Specialized training or certifications such as NHCAA, AHFI, CFE

*All telecommuters must 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 and various factors. Benefits and incentives are included.

Our mission is to help people live healthier lives and improve health equity. We are committed to diversity, equity, and inclusion, and an environment free from discrimination and drugs.