Senior Investigator

Senior Investigator PharmacyAt 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 Pharmacy 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 for conducting investigations which may include fieldwork to perform interviews and obtain records and/or other relevant documentation.Travel: Up to 50%. Applicants must be within commutable distance to Los Angeles County.If you reside in the greater Los Angeles, CA area, you'll enjoy the flexibility to telecommute* as you take on some tough challenges.Primary Responsibilities:Assess complaints of alleged misconduct received within the CompanyInvestigate medium to highly complex cases of fraud, waste and abuseDetect fraudulent activity by members, providers, employees and other parties against the CompanyDevelop and deploy the most effective and efficient investigative strategy for each investigationMaintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case tracking systemCollect and secure documentation or evidence and prepare summaries of the findingsParticipate in settlement negotiations and/or produce investigative materials in support of the latterCommunicate effectively, including written and verbal forms of communicationDevelop goals and objectives, track progress and adapt to changing prioritiesCollect, collate, analyze and interpret data relating to fraud, waste and abuse referralsEnsure compliance of applicable federal/state regulations or contractual obligationsReport suspected fraud, waste and abuse to appropriate federal or state government regulatorsComply with goals, policies, procedures and strategic plans as delegated by SIU leadershipCollaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetingsWhat 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 HolidaysMedical Plan options along with participation in a Health Spending Account or a Health Saving accountDental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage401(k) Savings Plan, Employee Stock Purchase PlanEducation ReimbursementEmployee DiscountsEmployee Assistance ProgramEmployee Referral Bonus ProgramVoluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 Associate's Degree with 2+ years of equivalent work experience with healthcare related employment2+ years of experience in healthcare, fraud, waste and abuse (FWA)2+ years of experience in state or federal regulatory FWA requirements2+ years of experience in analyzing data to identify fraud, waste and abuse trendsIntermediate level of proficiency with Microsoft Excel and WordIntermediate level of knowledge in pharmacy claims processingAbility to participate in legal proceedings, arbitration, and depositions at the direction of managementReside within the greater Los Angeles County, CA area with the ability to travel up to 50%Access to reliable transportation and valid driver's licensePreferred Qualifications:2+ years of experience in health care policies, procedures, and documentation standards2+ years of experience in developing investigative strategiesSpecialized knowledge/training in healthcare FWA investigationsActive affiliations:National Health Care Anti-Fraud Association (NHCAA)Accredited Health Care Fraud Investigator (AHFI)Certified Fraud Examiner (CFE)License and/or Certified Pharmacy Technician (CPhT)Operational experience with a pharmacy and/or pharmacy benefits manager (PBM)*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.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.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 #RED