Senior Investigator - Multiple Locations - Full-time / Part-time

Position Description:

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 Senior Investigator will be responsible for triaging, investigating and resolving instances of  Healthcare fraud and/or abusive conduct by the medical profession, insured members or the broker  community. This individual will be utilizing information from claims data analysis, plan members. The Senior Investigator will work on employee's conduct confidential investigations and document relevant findings. They will report any illegal activities in accordance with all laws and regulations. The Senior Investigator may also conduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation. They will act as a subject matter with identifying, communicating and recovering losses as deemed appropriate. Where applicable, they will provide testimonials regarding the investigation.

Primary Responsibilities:

• Manage the effective receipt, investigation and referral of allegations of fraud, waste and abuse
• Together with the UHC Compliance Officers 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 a liaison with Pharmacy Benefit Managers, MEDICs, ZPICs, PSCs, law enforcement, prosecutors, Administrative Law Judges, and other regulatory agencies in the area of 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 healthcare fraud

Required Qualifications:

• High School Diploma/GED.
• 2+ years experience working in a compliance organization, fraud investigation unit, or law enforcement agency.
• 2+ years Fraud Investigative experience.
• 4+ years experience with Microsoft Excel, Microsoft Word.
• Knowledge of Local, State & Federal laws and regulations pertaining to insurance.
• Verbal and written communication skills.

Preferred Qualifications:

• Experience with the group health business, particularly within claims.
• Associates Degree in the area of Criminal Justice or related field.
• Microsoft Access.
• Industry Certification.
• Previous experience with government Healthcare programs (Medicare, Medicaid and/or TriCare).
• Experience within the Insurance Claims Industry.

Core Competencies:

• Act Ethically
• Focus on Customers
• Act as Team Player
• Communicate Effectively
• Support Change and Innovation
• Deliver Quality Results
• Make Fact-Based Decisions

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