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 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 documentsSkilled in managing multiple cases with competing deadlines in a fast-paced environmentAbility to organize and synthesize large volumes of informationAssess complaints of alleged misconduct received within the CompanyDetect fraudulent activity by members, providers, employees, and other parties against the CompanyDevelop and deploy the most effective and efficient investigative strategy for each investigationMaintain accurate, current, and thorough case information in the Special Investigations Unit's (SIU's) case tracking systemCollect and secure documentation or evidence and prepare detailed and defensible summaries of the findingsParticipate in settlement negotiations and / or produce investigative materials in support ofCollect, collate, analyze, and interpret data relating to FWA referralsEnsure compliance of applicable federal / state regulations or contractual obligationsReport suspected FWA to appropriate federal or state government regulatorsComply with goals, policies, procedures, and strategic plans as delegated by SIU leadershipCollaborate with state / federal partners, at the discretion of leadership, to include attendance at workgroups or regulatory meetingsStrong communication skills, to include written and verbal forms of communicationDevelop goals and objectives, track progress and adapt to changing prioritiesYou'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 :
Bachelor's degree5+ years of experience working in a government, legal, healthcare, managed care and / or health insurance environment in a regulatory, privacy or compliance / investigative role with :Demonstrated advanced level of knowledge in health care FWA
Demonstrated advanced level of knowledge in state or federal regulatory FWA requirementsDemonstrated advanced level of knowledge analyzing data to identify FWA trendsDemonstrated advanced level of proficiency in Microsoft Excel and WordAbility to travel up to 25%Demonstrated ability to participate in legal proceedings, arbitration, and depositions at the direction of managementPreferred Qualifications :
Active affiliations :National Health Care Anti-Fraud Association (NHCAA)
Accredited Health Care Fraud Investigator (AHFI)Certified Fraud Examiner (CFE)CPT & ICD Coding experienceSpecialized knowledge / training in healthcare FWA investigationsExperience working with attorneys or government agenciesDemonstrated intermediate level of knowledge in health care policies, procedures, and documentation standardsDemonstrated intermediate level of skills in developing investigative strategiesAll employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyAt 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.