Principal Investigator - Remote
Caring. Connecting. Growing Together. The Principal Investigator is responsible for identification, investigation, and prevention of healthcare fraud, waste, and abuse. The Principal Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The Principal Investigator is responsible for conducting investigations which may include field work to perform interviews and obtain records and/or other relevant documentation. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities:
- Assess complaints of alleged misconduct received within the Company
- Investigate 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 latter
- 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
- Communicate effectively, including written and verbal forms of communication
- Develop goals and objectives, track progress and adapt to changing priorities
- Must participate in legal proceedings, arbitration, and depositions at the direction of management
Required Qualifications:
- Associate's Degree or higher
- 5+ years of experience in health care fraud, waste and abuse (FWA) investigations/audit
- 5+ years of experience with state/federal laws and regulations pertaining to healthcare FWA
- 5+ years of experience analyzing data to identify fraud, waste and abuse trends
- Advanced level of proficiency in Microsoft Excel and Word
- Ability to travel up to 25%
Preferred Qualifications:
- Active affiliation with National Health Care Anti-Fraud Association (NHCAA)
- Accredited Health Care Fraud Investigator (AHFI)
- Certified Fraud Examiner (CFE)
- Certified Professional Coder (CPC)
- Medical Laboratory Technician (MLT)
- Specialized knowledge/training in healthcare FWA investigations
All employees working remotely 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). The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. 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. Apply To this Job