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 fieldwork to perform interviews and obtain records and/or other relevant documentation.

Schedule: Monday-Friday Standard Business Hours

You'll enjoy the flexibility to telecommute* from anywhere within the U.Assess complaints of alleged misconduct received within the company

Investigatemediumtohighlycomplex 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

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

Bachelor's degree OR Associate's degree with 2+ years of equivalent work experience and healthcare related employment

• 2+ years of experience in healthcare, fraud, waste and abuse (FWA)
• 2+ years of experience in state or federal regulatory FWA requirements
• 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 25% of the time, as needed
• Ability to participate in legal proceedings, arbitration and depositions at the direction of management
• Demonstrated an intermediate level of knowledge in health care policies, procedures and documentation standards or 2-5 years of experience

Specialized knowledge/training in healthcare FWA investigations

National Health Care Anti-Fraud Association (NHCAA)

Accredited Health Care Fraud Investigator (AHFI)

*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 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. 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.