At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts on 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 Investigator is responsible for identifying, investigating, and preventing healthcare fraud, waste, and abuse (FWA). This role leverages claims data analysis, regulatory guidelines, and investigative methodologies to detect suspicious billing patterns and activities. The Investigator conducts thorough investigations, which may include fieldwork such as interviews and evidence collection, and ensures compliance with applicable regulatory requirements.
Schedule: Monday - Friday 8:00am - 4:30pm
If you reside in the state of Nebraska, you will have the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities:
- Assess and triage allegations of misconduct received within the organization
- Conduct investigations of low- to moderately complex fraud, waste, and abuse cases involving members, providers, employees, and third parties
- Identify potential fraudulent activities through data analysis, trend identification, and investigative techniques
- Develop and execute efficient, case-specific investigative strategies
- Maintain accurate, complete, and timely case documentation within the SIU case management system
- Gather, preserve, and analyze evidence; prepare clear and concise investigative summaries and reports
- Support settlement negotiations and provide documentation for legal or recovery actions
- Analyze referral data to identify patterns, trends, and emerging risks
- Ensure adherence to all applicable federal and state regulations, contractual obligations, and company policies
- Report suspected fraud, waste, and abuse to appropriate regulatory agencies as required
- Collaborate with internal teams and external partners, including state and federal agencies, as directed by SIU leadership
- Participate in regulatory meetings, workgroups, and cross-functional initiatives
- Communicate findings effectively through written reports and verbal presentations
- Establish and manage investigation goals, monitor progress, and adjust priorities as needed
- Participate in legal proceedings, including depositions, arbitration, and court testimony, as required
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:
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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
- Ability to travel up to 25% as required
- Intermediate level of proficiency in Microsoft Excel and Word
Preferred Qualifications:
- Experience in healthcare fraud, waste, and abuse investigations or auditing
- Knowledge of federal and state healthcare regulations related to FWA
- Experience with data analysis and trend identification in healthcare claims
- Formal training in healthcare fraud investigations
- National Health Care Anti-Fraud Association (NHCAA) affiliation
- Accredited Health Care Fraud Investigator (AHFI)
- Certified Fraud Examiner (CFE)
- Certified Professional Coder (CPC)
- Medical Laboratory Technician (MLT)
- Knowledge of investigative techniques and evidence handling practices
Soft Skills:
- Strong analytical and problem-solving skills
- Ability to interpret complex data and identify irregular patterns
- Effective written and verbal communication skills
- Strong organizational skills with the ability to manage multiple investigations simultaneously
*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 $49,700 to $88,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
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