600543 - Senior Healthcare FWA Investigator - Nationwide

Do you have experience investigating Healthcare Fraud, Waste & Abuse (FWA)?  Want to work with an elite team of some of the brightest and most inventive people in the healthcare & technology industries?  Optum is a health services business, part of the UnitedHealth Group family of companies, dedicated to making the health system work better for everyone. We serve people throughout the entire health system. Our team enjoys conversation-changing, life-changing, world-changing opportunities throughout their careers. Join us and see what it's like to do your life's best work.(sm)

The Senior Healthcare FWA Investigator will be responsible for investigating suspected and validated fraudulent behaviors in healthcare.  These cases can be very complex, and you will see an average of 5 to 10 new cases per week, and maintain a caseload of approximately 25-30 cases at any given time. 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. You will conduct confidential investigations, document relevant findings, and 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. When required, they will provide testimonials regarding the investigation.

NOTE: This position may work at one of our many UHG locations across the country.  This position may also be available as a telecommuting / work from home position if you are currently a UHG telecommuter.

Required Qualifications:

• Associates Degree (or higher) in the area of Criminal Justice or related field


• 3+ years of experience working in a FWA or Fraud investigations role


• Experience researching, compiling and reviewing data to develop error-free reports


• Exceptional written, verbal, analytical, organizational, time management, and problem solving skills


• An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to insurance


• Strong interpersonal skills required; objective, collaborative approach


• Ability to adapt in a dynamic and high-growth environment


• Proven ability to work independently


• Intermediate or better proficiency with MS Word & MS Excel

Preferred Qualifications:

• Previous experience as a telecommuter or working in a virtual workspace


• Experience with FWA regulatory reporting


• Experience with the group health business, particularly within claims


• Experience with compliance and regulatory reporting


• Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar


• MS Access experience

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to 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.

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