Senior Investigator - Remote in Ohio
UnitedHealthcare, Columbus, OH, 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. Role Overview
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. Responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation. If you reside in the state of Ohio, you will have the flexibility to telecommute as you take on some tough challenges. Schedule: Monday-Friday 8:00am - 4:30pm EST. 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 with 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 with 2+ years of equivalent work experience and healthcare related employment 2+ years of experience in health care 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 locally (in-state) up to 25% of the time, as needed Ability to participate in legal proceedings, arbitration and depositions at the direction of management Access to reliable transportation & valid US driver's license Preferred Qualifications
Specialized knowledge/training in healthcare FWA investigations National Health Care Anti-Fraud Association (NHCAA) Accredited Health Care Fraud Investigator (AHFI) Certified Fraud Examiner (CFE) Certified Professional Coder (CPC) Demonstrated an intermediate level of knowledge in health care policies, procedures, and documentation standards or 2-5 years of experience Demonstrated intermediate level of skills in developing investigative strategies or 2-5 years of experience All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Benefits & Compensation
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, benefits include a comprehensive package with incentives and recognition programs. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. Some of our offerings include: Paid Time Off with accrual from the first pay period plus 8 paid holidays Medical Plan options with Health Spending Account or Health Savings Account Dental, Vision, Life & AD&D Insurance, Short-term 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.) Additional Notice
All telecommuters must adhere to UnitedHealth Group's Telecommuter Policy. Salary disclosures and company-wide commitments: UnitedHealth Group is an Equal Employment Opportunity employer. We comply with all minimum wage laws. UnitedHealth Group is a drug-free workplace and may require a drug test before employment. Positions and benefits are subject to eligibility requirements. This description reflects the current job and may be amended from time to time.
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Caring. Connecting. Growing together. Role Overview
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. Responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation. If you reside in the state of Ohio, you will have the flexibility to telecommute as you take on some tough challenges. Schedule: Monday-Friday 8:00am - 4:30pm EST. 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 with 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 with 2+ years of equivalent work experience and healthcare related employment 2+ years of experience in health care 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 locally (in-state) up to 25% of the time, as needed Ability to participate in legal proceedings, arbitration and depositions at the direction of management Access to reliable transportation & valid US driver's license Preferred Qualifications
Specialized knowledge/training in healthcare FWA investigations National Health Care Anti-Fraud Association (NHCAA) Accredited Health Care Fraud Investigator (AHFI) Certified Fraud Examiner (CFE) Certified Professional Coder (CPC) Demonstrated an intermediate level of knowledge in health care policies, procedures, and documentation standards or 2-5 years of experience Demonstrated intermediate level of skills in developing investigative strategies or 2-5 years of experience All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Benefits & Compensation
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, benefits include a comprehensive package with incentives and recognition programs. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. Some of our offerings include: Paid Time Off with accrual from the first pay period plus 8 paid holidays Medical Plan options with Health Spending Account or Health Savings Account Dental, Vision, Life & AD&D Insurance, Short-term 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.) Additional Notice
All telecommuters must adhere to UnitedHealth Group's Telecommuter Policy. Salary disclosures and company-wide commitments: UnitedHealth Group is an Equal Employment Opportunity employer. We comply with all minimum wage laws. UnitedHealth Group is a drug-free workplace and may require a drug test before employment. Positions and benefits are subject to eligibility requirements. This description reflects the current job and may be amended from time to time.
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