Job Description
Senior InvestigatorAt 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.Responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.Schedule:Monday - Friday 8:00am - 4:30pmIf you reside in the state of Nebraska, you will have the flexibility to telecommute as you take on some tough challenges.Primary Responsibilities:Assess complaints of alleged misconduct received within the companyInvestigate medium to highly complex cases of fraud, waste and abuseDetect fraudulent activity by members, providers, employees and other parties against the companyDevelop and deploy the most effective and efficient investigative strategy for each investigationMaintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case tracking systemCollect and secure documentation or evidence and prepare summaries of the findingsParticipate in settlement negotiations and/or produce investigative materials in support of the latterCommunicate effectively, including written and verbal forms of communicationDevelop goals and objectives, track progress and adapt to changing prioritiesCollect, collate, analyze and interpret data relating to fraud, waste and abuse referralsEnsure compliance of applicable federal/state regulations or contractual obligationsReport suspected fraud, waste and abuse to appropriate federal or state government regulatorsComply with goals, policies, procedures and strategic plans as delegated by SIU leadershipCollaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetingsWhat are the reasons to consider working for UnitedHealth Group? 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.Some of our offerings include:Paid Time Off which you start to accrue with your first pay period plus 8 Paid HolidaysMedical Plan options along with participation in a Health Spending Account or a Health Saving accountDental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage401(k) Savings Plan, Employee Stock Purchase PlanEducation ReimbursementEmployee DiscountsEmployee Assistance ProgramEmployee Referral Bonus ProgramVoluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)More information can be downloaded at: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.Required Qualifications:Bachelor's Degree or Associate's Degree with 2years of equivalent work experience and healthcare related employment2years of experience in health care fraud, waste and abuse (FWA)2years of experience in state or federal regulatory FWA requirements2years of experience in analyzing data to identify fraud, waste and abuse trendsIntermediate level of proficiency in Microsoft Excel and WordAbility to travel locally up to 25% of the time, as neededAbility to participate in legal proceedings, arbitration and depositions at the direction of managementAccess to reliable transportation & valid US driver's licensePreferred Qualifications:Specialized knowledge/training in healthcare FWA investigationsNational 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 experienceDemonstrated intermediate level of skills in developing investigative strategies or 2-5 years of experiencePay 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).No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.The salary for this r