UnitedHealthcare
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Caring. Connecting. Growing together.
Senior Investigator You will work primarily in Ohio, with the flexibility to telecommute as you take on challenging investigations of healthcare fraud, waste, and abuse. Schedule: Monday‑Friday 8:00 am – 4:30 pm 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 SIU 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 U.S. driver’s license.
Preferred Qualifications
Specialized knowledge/training in healthcare FWA investigations.
National Health Care Anti‑Fraud Association (NHCAA) membership.
Accredited Health Care Fraud Investigator (AHFI) credential.
Certified Fraud Examiner (CFE) credential.
Certified Professional Coder (CPC) credential.
Demonstrated intermediate knowledge in health care policies, procedures, and documentation standards.
Demonstrated intermediate skills in developing investigative strategies.
All telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Benefits
Paid Time Off and 8 paid holidays.
Medical, dental, vision, and life & AD&D insurance, plus short‑term and long‑term disability.
401(k) savings plan and Employee Stock Purchase Plan.
Education reimbursement and employee discounts.
Employee Assistance Program and referral bonus program.
Voluntary benefits such as pet insurance and legal insurance.
Compensation Salary range: $58,800 to $105,000 annually, based on full‑time employment and applicable factors.
EEO Statement UnitedHealth Group is an Equal Employment Opportunity employer. We do not discriminate on the basis of race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status.
Drug‑Free Workplace Candidates are required to pass a drug test before beginning employment.
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Caring. Connecting. Growing together.
Senior Investigator You will work primarily in Ohio, with the flexibility to telecommute as you take on challenging investigations of healthcare fraud, waste, and abuse. Schedule: Monday‑Friday 8:00 am – 4:30 pm 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 SIU 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 U.S. driver’s license.
Preferred Qualifications
Specialized knowledge/training in healthcare FWA investigations.
National Health Care Anti‑Fraud Association (NHCAA) membership.
Accredited Health Care Fraud Investigator (AHFI) credential.
Certified Fraud Examiner (CFE) credential.
Certified Professional Coder (CPC) credential.
Demonstrated intermediate knowledge in health care policies, procedures, and documentation standards.
Demonstrated intermediate skills in developing investigative strategies.
All telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Benefits
Paid Time Off and 8 paid holidays.
Medical, dental, vision, and life & AD&D insurance, plus short‑term and long‑term disability.
401(k) savings plan and Employee Stock Purchase Plan.
Education reimbursement and employee discounts.
Employee Assistance Program and referral bonus program.
Voluntary benefits such as pet insurance and legal insurance.
Compensation Salary range: $58,800 to $105,000 annually, based on full‑time employment and applicable factors.
EEO Statement UnitedHealth Group is an Equal Employment Opportunity employer. We do not discriminate on the basis of race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status.
Drug‑Free Workplace Candidates are required to pass a drug test before beginning employment.
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