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The Senior Investigator reports directly to the Manager of Investigations. The Senior Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Senior Investigator is responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.

You'll enjoy the flexibility to telecommute* from anywhere within Louisiana as you take on some tough challenges.

Primary Responsibilities:

• Investigate medium to highly complex cases of fraud, waste and abuse
• Detect fraudulent activity by members, providers, employees and other parties against the Company
• Develop and deploy the most effective and efficient investigative strategy for each investigation
• Maintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case tracking system
• Collect and secure documentation or evidence and prepare summaries of the findings
• Participate in settlement negotiations and/or produce investigative materials in support of the later
• Communicate effectively, to include written and verbal forms of communication
• Develop goals and objectives, track progress and adapt to changing priorities
• Collect, collate, analyze and interpret data relating to fraud, waste and abuse referrals
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Report suspected fraud, waste and abuse to appropriate federal or state government regulators
• Comply with goals, policies, procedures and strategic plans as delegated by SIU leadership
• Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at work-groups or regulatory meetings

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) AND 2+ years of equivalent work experience with healthcare related employment
• 2-5 years of experience OR a demonstrated intermediate level of knowledge in health care fraud, waste and abuse (FWA)
• 2-5 years of experience OR a demonstrated intermediate level of knowledge in state or federal regulatory FWA requirements
• 2-5 years of experience OR a demonstrated intermediate level of knowledge analyzing data to identify fraud, waste and abuse trends
• 2-5 years of experience OR a demonstrated intermediate level of proficiency in Microsoft Excel and Word
• Ability to participate in legal proceedings, arbitration, and depositions at the direction of management
• Currently reside within the state of Louisiana or has the ability to relocate at their own expense
• Ability to travel up to 25% of the time

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

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