Senior Investigator
UnitedHealthcare, Dallas, TX, United States
At 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 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.
If you reside in the state of California, Texas, Georgia, New York, or Florida, you will have the flexibility to telecommute 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
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
Must reside in California, Texas, Georgia, New York, or Florida
Access to reliable transportation and valid US driver's license
Preferred Qualifications
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 affiliations:
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.
Benefits
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.)
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, 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.
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.
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Caring. Connecting. Growing together.
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.
If you reside in the state of California, Texas, Georgia, New York, or Florida, you will have the flexibility to telecommute 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
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
Must reside in California, Texas, Georgia, New York, or Florida
Access to reliable transportation and valid US driver's license
Preferred Qualifications
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 affiliations:
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.
Benefits
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.)
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, 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.
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.
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