Senior Investigator

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.

Ingenix, a UnitedHealth Group company, is one of the largest health care information and research companies in the industry. No one competitor offers the same breadth of products and services as Ingenix. In fact, our competitors strive to copy what we have done. We offer the most comprehensive set of data, technology and analytic capabilities. The power of our products and services help customers leverage information assets, enhance clinical and financial insight, increase the quality of health care delivery and administration and improve cost management.



Responsibilities:


Prevent and / or recover inappropriate health benefit payments due to abuse and fraud.


Identify areas of vulnerability and implement mechanisms to minimize the risk.


Conduct complex and / or sensitive investigations of providers suspected of fraud and abuse.


Create / maintain strong relationships with law enforcement personnel, Medicare Carriers and Intermediaries and state regulators.


Determine case strategies taking into consideration the legal, customer service and financial implications of each case.


Manage each case to appropriate conclusion, including recovery of claims amounts overpaid.


Provide leadership and guidance to less experienced investigators.


Function as a liaison with the Value Chain Partners and other United HealthCare fraud and abuse entities including Government Operations.


Represent United HealthCare and the AARP division at regional fraud and abuse meetings, as appropriate.


Conduct post-case evaluations to identify opportunities for increasing efficiencies




Job Requirements:

Requirements:
Action oriented.
Functional / technical skills.
Problem solving.
Priority setting.
Approachability.
Peer relationships.
Technical learning.
Working knowledge of health products and claim payment systems.
Personal computing skills (spreadsheet, work processing, database) and experience with mainframe systems.
Working knowledge of law enforcement approaches to health care fraud.
Familiarity with Medicare.
Dealing with ambiguity.
Creativity.
Planning.
Building team spirit.
Conflict management.
Self development.
Work quality and quantity.
Interpersonal skills.
Customer service skills.
Excellent oral and written communication skills.
College degree in business or related field and / or 5 years experience with group health business.
3 + years experience in fraud detection / prevention / investigation.
Law enforcement or investigative experience.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V