29 days old

Sr Investigator, Office Based - New Orleans or Baton Rouge, LA

New Orleans, LA 70112
  • Job Code
    890653

Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work.(sm)

The Senior Investigator will be responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. This individual will also data mine, conduct research and analyze providers by utilizing claims data, medical coding guidelines and their keen eye to identify abhorrent medical billing practices and patterns. In addition, the individual will be responsible to conduct investigations which may include field work to perform interviews and obtain medical records/ and other relevant documentation. The Senior Investigator will also act as subject matter expert in researching and communicating their findings both orally and in writing and will be responsible to report any illegal activities in accordance with all applicable laws. 

Primary Responsibilities:


The SIU Senior Investigator reports directly to the SIU Manager. The primary responsibility of the Senior Investigator is to investigate medium to highly complex cases of fraud, waste and abuse.Under the direction of the SIU Manager, the Senior Investigator's principle responsibilities include: 

  • Detecting fraudulent activity by members, providers, employees and other parties against the Company and deciding the most effective and efficient method of investigation
  • Maintaining accurate, current and thorough case information in the SIU Case Tracking Database
  • Securing documentation, either internally or externally, and preparing summaries of the findings from the documentation
  • Documenting the evidence and drawing conclusions based on the investigative findings and preparing summaries of the investigative findings and case outcome
  • Representing the Company in conducting settlement negotiations
  • Gathering objective evidence in support of investigation outcomes
  • Collecting, collating, analyzing and interpreting data, both internally and externally, relating to fraud, waste and abuse referrals
  • Controlling and maintaining Company and departmental data to ensure confidentiality in accordance with the Data Release Governance Program
  • Reporting suspected fraud, waste and abuse to appropriate federal or state government regulators
  • Attending at least 9 hours of continuing anti-fraud training annually

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.
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Posted: 2020-09-24 Expires: 2020-10-24

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Sr Investigator, Office Based - New Orleans or Baton Rouge, LA

UnitedHealth Group
New Orleans, LA 70112

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