Senior Investigator
About The Position
The Senior Investigator identifies, investigates, and helps prevent healthcare fraud, waste, and abuse. The role uses claims data, applicable guidelines, and other information to identify aberrant billing practices and patterns, and conducts investigations that may include fieldwork, interviews, and obtaining records or other relevant documentation. The position may be performed remotely from anywhere in the United States, with a preference for candidates residing in Texas or Louisiana. Telecommuters must adhere to UnitedHealth Group’s Telecommuter Policy, and the role requires travel of up to 25%.
Requirements
- Associate’s degree.
- At least 2 years of experience in fraud, waste, and abuse investigations or audit.
- At least 2 years of experience with state and federal laws and regulations pertaining to healthcare fraud, waste, and abuse.
- At least 2 years of experience analyzing data to identify fraud, waste, and abuse trends.
- Ability to travel up to 25%.
- Intermediate proficiency in Microsoft Excel and Word.
- Access to reliable transportation.
Nice To Haves
- Specialized 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) qualification.
- Statistical analysis experience.
Responsibilities
- Assess complaints of alleged misconduct received within the Company.
- Investigate medium- to high-complexity cases of fraud, waste, and abuse.
- Detect fraudulent activity by members, providers, employees, and other parties against the Company.
- Develop and deploy effective and efficient investigative strategies 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, as directed by 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 management’s direction.
Benefits
- Paid time off accrued starting with the first pay period.
- 8 paid holidays.
- Medical plan options and participation in a Health Spending Account or Health Savings Account.
- Dental insurance.
- Vision insurance.
- Life and AD&D insurance.
- Short-term 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, 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
Career Level
Senior
Education Level
Associate degree
