UnitedHealth Group

Senior Investigator

UnitedHealth Group$60K — $107K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • High School Diploma/GED
  • 5+ years of experience in Fraud/Waste/Abuse (FWA) investigations or Special Investigations Unit (SIU)
  • 2+ years in the health insurance claims industry
  • Experience with law enforcement or legal entities, or 3+ years of investigative fraud experience
  • 1+ year knowledge of behavioral health codes and service delivery
  • Intermediate proficiency in Microsoft Excel and Word
  • Ability to travel 25% within Tennessee
  • Reside in Tennessee

Responsibilities

  • Gather and analyze data to understand provider schemes
  • Utilize documentation controls for compliance and auditing
  • Collaborate with clinical coding consultants to assess coding validity
  • Create Investigation Summary reports communicating rationale to stakeholders
  • Identify patterns of Fraud/Waste/Abuse by collaborating with external sources
  • Conduct interviews and review medical documents as needed
  • Communicate with legal entities and client stakeholders

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase options
  • 401k contribution
  • Wide-ranging choice of benefits and incentives based on eligibility
Full Job Description
If reside in Tennessee, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Gather and analyze data and information gathered to determine behavior and understand provider/scheme at issue
  • Utilize appropriate documentation and tracking controls in the case tracking system to ensure compliance and auditability requirements are met
  • Collaborate with clinical coding consultant to apply knowledge of coding guidelines to determine validity of aberrances (SIU only)
  • Gather all relevant facts to articulate behavior through an Investigation Summary and compliance package. Communicate clear rationale for investigation processes and outcomes to Client, Regulator and stakeholders
  • Collaborate with a variety of external sources to identify current and emerging patterns and schemes related for FWA to ensure additional TIP submission
  • Perform member and provider interviews, and review medical documentation as needed
  • Communicate with legal, Law Enforcement, clients and business partners as needed


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.

Required Qualifications:

  • High School Diploma/GED
  • 5+ years of experience working in a FWA / SIU or Fraud investigations role for Tennessee location
  • 2+ years of experience within the health insurance claims industry
  • 2+ years of experience working with law enforcement or legal entities or 3+ years of Investigative experience with fraud investigations
  • 1+ years of knowledge and/or experience with behavioral health codes and service delivery
  • Intermediate level of proficiency in Microsoft Excel (pivot tables and macros) and Word (documents)
  • Ability to travel 25% of the time in the state of Tennessee for client on-site visits
  • Reside in the state of Tennessee


Preferred Qualifications:

  • Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar
  • Experience with computer research
  • Experience with regulatory compliance
  • Experience with data analysis as it relates to financial recovery/settlements
  • Familiar with CPT code terminology


*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 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

#RPO #GREEN

About UnitedHealth Group

UnitedHealth Group is a medical facility. They offer health technology, health finance, and pharmacy services. They are utilizing clinical data and intelligence to assist in the redesign, automation, and deployment of technology to streamline administrative operations and clinical decision-making. Payment systems for both consumers and providers are critical components of a health-care system.

UnitedHealth Group Careers

Joining UnitedHealth Group means becoming part of a diverse team dedicated to making a difference. As a leader in health services and innovation, our company offers a variety of job opportunities that allow professionals to leverage their skills, drive innovation, and improve lives. Work You’ll Do At UnitedHealth Group, you’ll contribute to a mission-focused environment where your expertise will influence the health and well-being of people worldwide. Our employment opportunities span across a wide range of disciplines, from healthcare specialists to data analysts, ensuring that your career journey is both dynamic and rewarding. Transform Healthcare with Your Expertise UnitedHealth Group stands at the forefront of health innovation. Our team collaborates to deliver solutions that lead to better patient outcomes. Working with us, you’ll find yourself at the intersection of technology, healthcare, and leadership, providing key insights that drive industry transformation. Join Our Global Team As part of our team, you’ll engage with over 300,000 professionals globally, dedicated to building a diverse and inclusive workplace. UnitedHealth Group is not just a company; it’s a community where you can grow your career through continuous learning and leadership opportunities. Our commitment to diversity training ensures that every team member can thrive. UnitedHealth Group Career Development We are committed to your professional growth. Explore career paths filled with promising job opportunities and internships that will harness your potential and expand your capabilities. Whether you’re a seasoned professional or a recent graduate, you’ll find that our career development programs support your ambition at every level. Innovative Work Environment At UnitedHealth Group, innovation is at the core of our operations. We encourage our team to bring forward-thinking ideas that challenge the status quo and lead to breakthrough improvements in patient care. Be Part of a Great Team Our culture fosters a collaborative and supportive environment where every member’s contribution is valued. Enjoy the benefits of being part of a global team that’s committed to making a difference in people’s lives. Future-Proof Your Career With UnitedHealth Group, your career is future-proof. Dive into a range of positions that offer both challenges and rewards. Our robust support system includes unmatched training, development programs, and certification support to propel your career forward. Stay Connected Join Our Team Discover the right position that matches your skills and interests. We are always hiring and look for passionate, curious, and solution-driven team players. Search UnitedHealth Group jobs today and take the first step towards a fulfilling career. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can use today—all from the people who work here. Read Careers Blog Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UnitedHealth Group.
Learn more about UnitedHealth Group
Size
350,000 employees
Market Cap
$493.1 billion
Industry
Net Income
$15.4 billion
Founded
1974
5 Year Trend
+9.2%
Revenue
$257.1 billion
NASDAQ

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