Principal Investigator - Remote - Remote Eligible

Principal Investigator

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 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 fieldwork 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:

• Investigate highly complex cases of fraud, waste, and abuse (FWA)
• Demonstrated ability to think critically and analytically when evaluating complex healthcare data and documents
• Skilled in managing multiple cases with competing deadlines in a fast-paced environment
• Ability to organize and synthesize large volumes of information
• Assess complaints of alleged misconduct received within the Company
• 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 detailed and defensible summaries of the findings
• Participate in settlement negotiations and/or produce investigative materials in support of
• Collect, collate, analyze, and interpret data relating to FWA referrals
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Report suspected FWA 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 leadership, to include attendance at workgroups or regulatory meetings
• Strong communication skills, to include written and verbal forms of communication
• Develop goals and objectives, track progress and adapt to changing priorities

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
• 5+ years of experience working in a government, legal, healthcare, managed care and/or health insurance environment in a regulatory, privacy or compliance/investigative role with:
• Demonstrated advanced level of knowledge in health care FWA
• Demonstrated advanced level of knowledge in state or federal regulatory FWA requirements
• Demonstrated advanced level of knowledge analyzing data to identify FWA trends
• Demonstrated advanced level of proficiency in Microsoft Excel and Word
• Ability to travel up to 25%
• Demonstrated ability to participate in legal proceedings, arbitration, and depositions at the direction of management

Preferred Qualifications:

• Active affiliations:
• National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• CPT & ICD Coding experience
• Specialized knowledge/training in healthcare FWA investigations
• Experience working with attorneys or government agencies
• Demonstrated intermediate level of knowledge in health care policies, procedures, and documentation standards
• Demonstrated intermediate level of skills in developing investigative strategies