The
SeniorInvestigator 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. The
Senior Investigator is responsible for conducting investigations which may include fieldwork to perform interviews and obtain records and/or other relevant documentation.
Office location: Warwick, RI
Hybrid role with expectation to work out of the Warwick, RI office approximately 3-4 times per week.
25-50% of expected travel within Rhode Island.
If you live near Warwick, RI, you will enjoy the flexibility of a hybrid-remote role as you take on some tough challenges.
Primary Responsibilities:- Assess complaints of alleged misconduct received within the Company
- Investigate medium to high 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
- 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 workgroups or regulatory meetings
- Communicate effectively, including written and verbal forms of communication
- Develop goals and objectives, track progress and adapt to changing priorities
- Must participate in legal proceedings, arbitration, and depositions at the direction of management
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:- Associate's degree
- 2+ years of experience in fraud, waste and abuse (FWA) investigations/audit
- 2+ years of experience with state/federal laws and regulations pertaining to healthcare FWA
- 2+ years of experience in analyzing data to identify fraud, waste and abuse trends
- Demonstrated intermediate level of proficiency in Microsoft Excel and Word
- Ability to travel up to 50%
- Reside within a commutable distance to Warwick, RI
- Access to reliable transportation and valid US driver's license
Preferred Qualifications: - Specialized knowledge/training in healthcare FWA investigations
- Active affiliations with the National Health Care Anti-Fraud Association (NHCAA)
- Accredited Health Care Fraud Investigator (AHFI)
- Certified Fraud Examiner (CFE)
- Certified Professional Coder (CPC)
- Medical Laboratory Technician (MLT)
*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 $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
