The
Principal Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste, and abuse. The
Principal Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The
Principal Investigator is responsible for conducting investigations which may include fieldwork to perform interviews and obtain records and/or other relevant documentation.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office for a minimum of four days per week.
Primary Responsibilities:- Investigate highly complex cases of fraud, waste, and abuse (FWA)
- Demonstrated ability to think critically and analytically when evaluating complex healthcare data and documents
- Skilled in managing multiple cases with competing deadlines in a fast-paced environment
- Ability to organize and synthesize large volumes of information
- Assess complaints of alleged misconduct received within the Company
- 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 detailed and defensible summaries of the findings
- Participate in settlement negotiations and/or produce investigative materials in support of
- Collect, collate, analyze, and interpret data relating to FWA referrals
- Ensure compliance of applicable federal/state regulations or contractual obligations
- Report suspected FWA 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 leadership, to include attendance at workgroups or regulatory meetings
- Strong communication skills, to include written and verbal forms of communication
- Develop goals and objectives, track progress and adapt to changing priorities
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
- 5+ years of experience working in a government, legal, healthcare, managed care and/or health insurance environment in a regulatory, privacy or compliance/investigative role
- Advanced level of knowledge in health care FWA
- Advanced level of knowledge in state or federal regulatory FWA requirements
- Advanced level of knowledge analyzing data to identify FWA trends
- Advanced level of proficiency in Microsoft Excel and Word
- Ability to travel up to 25%
- Demonstrated ability to participate in legal proceedings, arbitration, and depositions at the direction of management
- Access to reliable transportation and valid US driver's license
Preferred Qualifications:- Active affiliations:
- National Health Care Anti-Fraud Association (NHCAA)
- Accredited Health Care Fraud Investigator (AHFI)
- Certified Fraud Examiner (CFE)
- CPT & ICD Coding experience
- Specialized knowledge/training in healthcare FWA investigations
- Experience working with attorneys or government agencies
- Demonstrated intermediate level of knowledge in health care policies, procedures, and documentation standards
- Demonstrated intermediate level of skills in developing investigative strategies
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay 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 role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
