Senior Investigator - Remote in Maryland
About the position
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, and growing together. The Senior Investigator is responsible for the 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. This role involves conducting investigations which may include fieldwork to perform interviews and obtain records and/or other relevant documentation. You'll enjoy the flexibility to telecommute from anywhere within Maryland as you take on some tough challenges. The challenge for you will be the high volume of cases on your plate at one time. You will be part of a team responsible for triaging, investigating, and resolving instances of healthcare fraud and/or abusive conduct. You will spend your time doing audits, claims data analysis, conducting investigations, and putting together your findings. 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.
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 later
,
Communicate effectively, to include 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 work-groups or regulatory meetings
Requirements
Associates Degree (or higher) AND 2+ years of equivalent work experience with 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 analyzing data to identify fraud, waste and abuse trends
,
Intermediate level of proficiency in Microsoft Excel and Word
,
Ability to travel 25% of the time
,
Must participate in legal proceedings, arbitration, and depositions at the direction of management
Nice-to-haves
Demonstrated 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
,
Specialized knowledge/training in healthcare FWA investigations
Benefits
Health Insurance
,
401K Plan
,
Vacation & Paid Time Off
Apply Now
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, and growing together. The Senior Investigator is responsible for the 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. This role involves conducting investigations which may include fieldwork to perform interviews and obtain records and/or other relevant documentation. You'll enjoy the flexibility to telecommute from anywhere within Maryland as you take on some tough challenges. The challenge for you will be the high volume of cases on your plate at one time. You will be part of a team responsible for triaging, investigating, and resolving instances of healthcare fraud and/or abusive conduct. You will spend your time doing audits, claims data analysis, conducting investigations, and putting together your findings. 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.
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 later
,
Communicate effectively, to include 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 work-groups or regulatory meetings
Requirements
Associates Degree (or higher) AND 2+ years of equivalent work experience with 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 analyzing data to identify fraud, waste and abuse trends
,
Intermediate level of proficiency in Microsoft Excel and Word
,
Ability to travel 25% of the time
,
Must participate in legal proceedings, arbitration, and depositions at the direction of management
Nice-to-haves
Demonstrated 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
,
Specialized knowledge/training in healthcare FWA investigations
Benefits
Health Insurance
,
401K Plan
,
Vacation & Paid Time Off
Apply Now