Senior Investigator

Position Overview The Senior Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Senior Investigator will conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation. You will enjoy the flexibility to telecommute from anywhere within the U.S. 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 latter Communicate effectively, including 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 Benefits and Compensation Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays Medical Plan options along with participation in a Health Spending Account or a Health Saving account Dental, Vision, Life & AD&D Insurance along with Short‑term disability 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 (pet insurance, legal insurance, LTC Insurance, etc.) 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. Required Qualifications Bachelor's degree OR Associate's degree plus two years of equivalent work experience with healthcare related employment Intermediate level of knowledge in health care fraud, waste and abuse (FWA) OR 2+ years of experience Intermediate level of knowledge in state or federal regulatory FWA requirements OR 2+ years of experience Intermediate level of knowledge analyzing data to identify fraud, waste and abuse trends OR 2+ years of experience Intermediate level of proficiency in Microsoft Excel and Word OR 2+ years of experience Ability to travel up to 25% of the time Must be willing and able 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 Must reside in California, Texas, Georgia, New York, or Florida Intermediate level of knowledge in health care policies, procedures, and documentation standards or 2-5 years of experience Intermediate level of skills in developing investigative strategies or 2-5 years of experience Specialized knowledge/training in healthcare FWA investigations Active affiliation: National Health Care Anti‑Fraud Association (NHCAA) Accredited Health Care Fraud Investigator (AHFI) Certified Fraud Examiner (CFE) Certified Professional Coder (CPC) Medical Laboratory Technician (MLT) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. 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. #J-18808-Ljbffr UnitedHealth Group