Investigator - New Mexico
About The Position
The Investigator is responsible for identifying, investigating, and preventing healthcare fraud, waste, and abuse. The role uses claims data, applicable guidelines, and other sources to identify aberrant billing practices and patterns. Investigations may include fieldwork to conduct interviews and obtain records or other relevant documentation. This position is open to candidates who reside in New Mexico and offers the flexibility to telecommute, subject to UnitedHealth Group’s Telecommuter Policy. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. Central Time. The role may require travel up to 25% and participation in legal proceedings, arbitration, and depositions as directed by management.
Requirements
- Associate’s degree.
- Intermediate proficiency in Microsoft Excel and Word.
- Ability to travel up to 25%.
- Access to reliable transportation and a valid U.S. driver’s license.
- Must reside in New Mexico.
Nice To Haves
- Experience in healthcare fraud, waste, and abuse investigations or audits.
- Experience with state and federal laws and regulations pertaining to healthcare fraud, waste, and abuse.
- Experience analyzing data to identify fraud, waste, and abuse trends.
- Knowledge or training in healthcare fraud, waste, and abuse investigations.
- Active affiliation with the National Health Care Anti-Fraud Association (NHCAA).
- Accredited Health Care Fraud Investigator (AHFI) credential.
- Certified Fraud Examiner (CFE) credential.
- Certified Professional Coder (CPC) credential.
- Medical Laboratory Technician (MLT) credential.
- Statistical analysis skills.
Responsibilities
- Assess complaints of alleged misconduct received within the Company.
- Investigate low- to medium-complexity cases of fraud, waste, and abuse.
- Detect fraudulent activity by members, providers, employees, and other parties against the Company.
- Develop and deploy an effective and efficient investigative strategy for each investigation.
- Maintain accurate, current, and thorough case information in the SIU case tracking system.
- Collect and secure documentation or evidence and prepare summaries of findings.
- Participate in settlement negotiations and/or produce investigative materials in support of them.
- Collect, collate, analyze, and interpret data relating to fraud, waste, and abuse referrals.
- Ensure compliance with applicable federal and 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 and federal partners, at the discretion of SIU leadership, including attending workgroups or regulatory meetings.
- Communicate effectively in writing and verbally.
- Develop goals and objectives, track progress, and adapt to changing priorities.
- Participate in legal proceedings, arbitration, and depositions at the direction of management.
Benefits
- Paid time off accrued starting with the first pay period.
- Eight paid holidays.
- Medical plan options.
- Health Spending Account or Health Savings Account participation.
- Dental insurance.
- Vision insurance.
- Life and AD&D insurance.
- Short-term disability coverage.
- 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, including pet insurance, legal insurance, and long-term care insurance.
- Performance rewards and incentive and recognition programs.
- Equity stock purchase and 401(k) contribution, subject to eligibility requirements.
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
