Requisition number: 2365718
Job category: Regulatory & Compliance
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. Growing together.
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.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
RPO #GREEN
