Manager Of Investigations - Remote In Raleigh, NC Area - Remote Eligible

Caring. Connecting. Growing Together.

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?

The Manager of Investigations reports directly to the Director of Investigations. The Manager of Investigations is responsible for the direct oversight of investigators whose primary roles are: identification, investigation and prevention of healthcare fraud, waste and abuse.

If you are located in North Carolina, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Managerial oversight of all types of fraud, waste and abuse cases, to include all levels of complexity
• Ensure compliance with the UnitedHealthcare (UHC) Fraud, Waste and Abuse Program
• Provide guidance to investigators on effective and efficient investigative strategies
• Ensure investigators maintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case tracking system
• Participate in settlement negotiations and/or produce investigative materials in support of the later
• Collect, collate, analyze and interpret data relating to fraud, waste and abuse referrals
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Ensure investigators compliance 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:

• 3+ years of experience working in a government, legal, healthcare, managed care and/or health insurance environment in a regulatory, privacy or compliance/investigative role
• Proven broad knowledge and experience in health care fraud, waste and abuse (FWA) investigations
• Proven broad knowledge and experience in state and federal regulatory FWA requirements
• Advanced level of proficiency in Microsoft Excel and Word
• Demonstrated advanced level of knowledge with local, state/federal laws and regulations pertaining to healthcare fraud, waste and abuse (FWA)
• Proven general knowledge of medical benefits, specialty benefits and pharmacy benefits
• Proven general knowledge of compliance program policies, procedures and documentation standards
• Willing to participate in legal proceedings, arbitrations, depositions, etc.
• Ability to travel up to 25%
• Reside in North Carolina within a commutable distance to Raleigh, NC

Preferred Qualifications:

• Active affiliations:
• National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• Certified Professional Coder (CPC)
• 2+ years of direct supervisory experience
• Specialized knowledge/training in healthcare FWA investigations
• Demonstrated above average skills in data manipulation
• Demonstrated excellent skills in developing investigative strategies
• Ability to supervise a team
• Ability to communicate effectively, to include written and verbal forms of communication

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 $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.