Senior Investigator - Telecommute

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. 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. The Senior Investigator is responsible for conducting investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.

If you reside in the state of New Mexico, you will have the flexibility to telecommute as you take on some tough challenges.

Schedule: Monday-Friday 8-4:30 CST

Assess complaints of alleged misconduct received within the Company

Investigate medium to high complex cases of fraud, waste, and abuse

Maintain accurate, current, and thorough case information in the Special Investigations Unit's (SIU's) case tracking system

Participate in settlement negotiations and/or produce investigative materials in support of the latter

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

Must participate in legal proceedings, arbitration, and depositions at the direction of management

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 Assistance Program

Employee Referral Bonus Program

Voluntary 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 direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

2+ years of experience in fraud, waste and abuse (FWA) investigations/audit

2+ years of experience with state/federal laws and regulations pertaining to healthcare FWA

2+ years of experience in analyzing data to identify fraud, waste and abuse trends

Intermediate level of proficiency in Microsoft Excel and Word

Ability to travel up to 50%, access to reliable transportation, and valid US' driver's license

Specialized knowledge/training in healthcare FWA investigations

Active affiliations with the National Health Care Anti-Fraud Association (NHCAA)

Accredited Health Care Fraud Investigator (AHFI)

Certified Fraud Examiner (CFE)

Medical Laboratory Technician (MLT)

Statistical Analysis

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). 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. 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. 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.