Talent.com
serp_jobs.error_messages.no_longer_accepting
Senior Investigator

Senior Investigator

UnitedHealth GroupMiramar, FL, United States
job_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

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 for conducting investigations which may include field work to perform interviews and obtain records and / or other relevant documentation.

Schedule : Monday-Friday Standard Business Hours

You'll enjoy the flexibility to telecommute

  • from anywhere within the United States. Preference for those residing in Florida.

Primary Responsibilities :

  • Assess complaints of alleged misconduct received within the company
  • Investigate medium to highly complex cases of fraud, waste and abuse
  • Detecting 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 latter
  • Communicate effectively, including 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 workgroups or regulatory meetings
  • 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 : http : / / uhg.hr / uhgbenefits
  • 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 :

  • Bachelor's Degree OR Associate's Degree with 2+ years of equivalent work experience and healthcare related employment
  • 2+ years of experience in health care fraud, waste and abuse (FWA)
  • 2+ years of experience in state or federal regulatory FWA requirements
  • 2+ years of experience in analyzing data to identify fraud, waste and abuse trends
  • Intermediate level of proficiency in Microsoft Excel and Word
  • Ability to travel locally (in-state) up to 25% of the time, as needed
  • Ability to participate in legal proceedings, arbitration and depositions at the direction of management
  • Access to reliable transportation and valid US driver's license
  • Preferred Qualifications :

  • Demonstrated an intermediate level of knowledge in health care policies, procedures and documentation standards or 2-5 years of experience
  • Demonstrated intermediate level of skills in developing investigative strategies or 2-5 years of experience
  • Specialized knowledge / training in healthcare FWA investigations
  • National Health Care Anti-Fraud Association (NHCAA)
  • Accredited Health Care Fraud Investigator (AHFI)
  • Certified Fraud Examiner (CFE)
  • All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
  • Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

    Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

    Application Deadline : This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

    At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

    UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

    #RPO #GREEN

    serp_jobs.job_alerts.create_a_job

    Investigator • Miramar, FL, United States

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    Remote Senior Plaintiff Associate / Counsel

    Remote Senior Plaintiff Associate / Counsel

    Scion StaffingMiami, FL, United States
    serp_jobs.filters.remote
    serp_jobs.job_card.permanent +1
    Remote Senior Plaintiff Associate / Counsel.Remote Senior Plaintiff Associate / Counsel.Remote Senior Plaintiff Associate / Counsel. Be among the first 25 applicants.Remote Senior Plaintiff Associat...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Kentucky Licensed Senior SIU Investigator

    Kentucky Licensed Senior SIU Investigator

    VirtualVocationsBoca Raton, Florida, United States
    serp_jobs.job_card.full_time
    A company is looking for a Senior SIU Investigator to investigate allegations of healthcare fraud and abuse activity.Key Responsibilities Investigate possible waste, abuse, and fraud leads and do...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Senior Compliance Auditor

    Senior Compliance Auditor

    New Edge Associates a Talent Acquisition FirmCoral Gables, FL, US
    serp_jobs.job_card.full_time
    New Edge Associates is partnered with a well-known bank to search for a Senior Compliance Auditor for their branch in Coral Gables, Miami. Must have banking experience to be considered for the role....serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    Military Intelligence Systems Maintainer / Integrator

    Military Intelligence Systems Maintainer / Integrator

    United States ArmyMiami, FL, United States
    serp_jobs.job_card.part_time +1
    Military Intelligence Systems Maintainer / Integrator Job Overview : You’ll develop expertise in maintaining, testing, and repairing high-tech communication and electronic systems.You'll work hands-o...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Fraud Investigator

    Fraud Investigator

    VirtualVocationsHialeah, Florida, United States
    serp_jobs.job_card.full_time
    A company is looking for a Fraud Investigator to protect members' financial well-being by investigating fraudulent activities. Key Responsibilities Lead investigations into fraud cases using inter...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    LAW ENFORCEMENT INVESTIGATOR II - 43001118

    LAW ENFORCEMENT INVESTIGATOR II - 43001118

    Florida State JobsFort Lauderdale, FL, US
    serp_jobs.job_card.full_time
    Law Enforcement Investigator II - 43001118.The State Personnel System is an E-Verify employer.For more information click on our E-Verify Website. Working Title : Law Enforcement Investigator II - 430...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    AML Investigator

    AML Investigator

    Valley National BancorpMiami, FL, US
    serp_jobs.job_card.full_time
    Responsibilities include but are not limited to : .Review and analyze alerts generated by the Bank's electronic monitoring software to make a determination as to whether activity warrants further rev...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Investigations Specialist

    Investigations Specialist

    VirtualVocationsHialeah, Florida, United States
    serp_jobs.job_card.full_time
    A company is looking for an Investigations Specialist (Remote).Key Responsibilities Conduct investigations to locate individuals and businesses for service of process Communicate investigation f...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Surveillance Investigator

    Surveillance Investigator

    Allied UniversalFort Lauderdale, Florida, United States
    serp_jobs.job_card.full_time
    Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services.Allied Universal Compliance and Investigation Services is the premier destination for a career in...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Principal Investigator l Part-Time l Orlando & Tampa l Multiple Specialties - 245392

    Principal Investigator l Part-Time l Orlando & Tampa l Multiple Specialties - 245392

    MedixHollywood, FL, US
    serp_jobs.job_card.part_time
    As a Principal Investigator, you will provide medical oversight and leadership for clinical trials.You will be responsible for ensuring subject safety, regulatory compliance, and protocol adherence...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Senior Auditor

    Senior Auditor

    Contact Government ServicesMiami, FL, US
    serp_jobs.job_card.full_time
    Miami, FL / Remote / Hybrid / Tampa, FL.Employment Type : Full Time, Mid-level.Department : Financial Services.CGS is seeking a Senior Auditor who will assist the district legal staff by conducting m...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Crime Gun Intelligence (CGI) Specialist Level I (A) - Ft. Lauder

    Crime Gun Intelligence (CGI) Specialist Level I (A) - Ft. Lauder

    Clearance JobsFort Lauderdale, FL, US
    serp_jobs.job_card.full_time
    Public Trust Intelligence Position.Eagle Harbor is an emerging specialty consulting firm focused on providing innovative strategic planning, project development, and management solutions.We are a s...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Loss Prevention Investigator- Bal Harbour

    Loss Prevention Investigator- Bal Harbour

    Neiman MarcusMiami Beach, FL, US
    serp_jobs.job_card.full_time
    Neiman Marcus Group is a relationship business that leads with love in everything we dofor our customers, associates, brand partners, and communities. Our legacy of innovating and our culture of Bel...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    SPECIAL AGENT

    SPECIAL AGENT

    Florida State JobsPompano Beach, FL, US
    serp_jobs.job_card.full_time
    The Florida Department of Law Enforcement (FDLE) is currently seeking experienced Law Enforcement Investigators to fill multiple Special Agent positions throughout the state.Positions are available...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Criminal Investigator (Reemployed Annuitants and ICTAP eligibles)

    Criminal Investigator (Reemployed Annuitants and ICTAP eligibles)

    US Government JobsMiami, FL, US
    serp_jobs.job_card.full_time
    The Secret Service is seeking retirees of the Federal Employee Retirement System (FERS) or Civil Service Retirement System (CSRS) to support our integrated mission and impart knowledge and experien...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Senior Applied Scientist

    Senior Applied Scientist

    VirtualVocationsTamarac, Florida, United States
    serp_jobs.job_card.full_time
    A company is looking for a Senior Applied Scientist - Observability Data Platform.Key Responsibilities Design and prototype intelligent systems for AI-native observability Apply reinforcement le...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Physician / Psychiatry / Florida / Permanent / Psychiatric Principal Investigator Job

    Physician / Psychiatry / Florida / Permanent / Psychiatric Principal Investigator Job

    ConfidentialHialeah, FL, US
    serp_jobs.job_card.permanent
    The Principal investigator is responsible for the oversight and execution of Psychiatric clinical trials testing new medications on the behalf of the sponsor / pharmaceutical companies.The investigat...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Senior Associate

    Senior Associate

    Lovegrove & Lastella, PLLCPompano Beach, FL, US
    serp_jobs.job_card.full_time
    Lovegrove & Lastella, PLLC is an established and growing law firm located in Broward County, Florida, looking to expand its first-party property insurance defense practice.We are currently seek...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Complaint Investigator

    Complaint Investigator

    VirtualVocationsHialeah, Florida, United States
    serp_jobs.job_card.full_time
    A company is looking for a Complaint Investigator.Key Responsibilities Review service records to identify product issues related to medical device / IVD quality complaints Document findings for ea...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Financial Investigator

    Financial Investigator

    Contact Government ServicesMiami, FL, US
    serp_jobs.job_card.temporary
    CGS is seeking a Financial Investigator to join our team providing legal support and investigative services to a large federal agency. CGS brings motivated, highly skilled, and creative people toget...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30