Senior Investigator - Baton Rouge, LA - Full-time / Part-time

Bring
us your experience, your head for strategy, your strength with
relationships and your eye for opportunity. In return we offer an
unmatched place to grow and develop your career among a richly diverse
group of businesses driven by the power and stability of a leading
health care organization. Come help us heal and strengthen the health
care system as you do your life's best work.(sm)

The SIU
Senior Investigator, working under the general direction and oversight of the
SIU Manager will: Conduct
complex investigations involving suspected civil or criminal fraud in
connection with the Louisiana Medicaid program.

Primary Responsibilities:

• Provide oversight for the
  effective receipt, research and response to Requests for Information
  related to the Louisiana Medicaid program.
• Manage the effective receipt,
  investigation and referral of allegations of fraud, waste and abuse in
  connection to the provision of Louisiana Medicaid service.
• Together with the Louisiana Compliance
  Officer and other key Corporate Responsibility and Compliance staff,
  identify gaps and inefficiencies in existing policies and procedures and
  suggest effective and efficient solutions.
• Provide coordinating oversight of
  subcontractors, vendors and downstream entities in connection with
  auditing and monitoring activities related to Louisiana Medicaid fraud,
  waste and abuse.
• Act as primary liaison with
  Pharmacy Benefit Managers, MEDICs, ZPICs, PSCs, law enforcement,
  prosecutors, Administrative Law Judges, and other regulatory agencies in
  the area of Louisiana Medicaid fraud, waste and abuse detection,
  investigation and reporting.
• Obtain and analyze claims
  billing and payment data as necessary in the course of conducting complex
  investigations of allegations of criminal or civil Medicaid fraud

• Bachelor's
  Degree in Business, Criminal Justice, or related field OR High School
  Diploma with 6+ years experience working in a Compliance organization,
  Fraud Investigation Unit, or Law Enforcement Agency.
• 2+
  years of experience working in a Compliance organization, Fraud
  Investigation Unit, or Law Enforcement Agency (Healthcare Fraud
  experience preferred). 
  
• Previous experience with Government Healthcare programs (Medicare, Medicaid and/or TriCare).
  

Preferred Qualifications:

• Healthcare Fraud experience.
• Industry Certification (CFE, AHFI) preferred.A63.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.