Senior FWAE Investigator

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration, and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Schedule: Monday-Friday standard business hours. No nights, no weekends, and no holidays.

Primary Responsibilities:

• Conduct confidential investigations, document relevant findings, and report any illegal activities in accordance with all laws and regulations
• Review claims, look for patterns of potential fraud, waste and/or abuse and interact with medical providers to request medical records for investigations
• Conduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation
• The challenge for you will be the high volume of cases on your plate at one time. You will be part of a team responsible for triaging, investigating, and resolving instances of healthcare fraud and/or abusive conduct. You will spend your time doing audits, claims data analysis, conducting investigations and putting together your findings

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: {apply below}

You’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:

• Associates Degree or higher in Criminal Justice (or related field) with 2+ years of experience in a position investigating fraud or a High School Diploma/GED with 5+ years of experience working in a Special Investigations Unit or fraud investigations role
• 2+ years of experience in an investigative role working with healthcare claims, managed care and/or within a health insurance environment
• Intermediate levle of proficiency in MS Excel (ability to use pivot tables, formulas, functions, etc.)
• Intermediate level of proficiency in MS Word (ability to create/edit documents)
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state, and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

• Bachelor's degree, undergraduate degree in Criminal Justice or related field
• 2+ years of experience working with Law Enforcement agencies at the Local, State & Federal level pertaining to healthcare insurance fraud (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy and/or commercial plans)
• Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $54,400 to $97,000. The salary range for Connecticut / Nevada residents is $60,000 to $106,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and 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.

Job Key words: FWA, fraud, waste, abuse, investigator, investigation, legal, law, enforcement, police, healthcare, claims, telecommute, remote, work from home, #RPO, #Green

Recommended Skills

• Auditing
• Certified Fraud Examiner
• Claim Processing
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• Criminal Justice
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