Field Based Senior Investigator in Florida
Company: UnitedHealthcare
Location: Miami
Posted on: May 12, 2025
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Job Description:
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 -Senior Investigator is responsible for identification,
investigation and prevention of healthcare fraud, waste and abuse.
The Senior Investigator will utilize claims data, applicable
guidelines and other sources of information to identify aberrant
billing practices and patterns. The Senior Investigator is
responsible to conduct investigations which may include field work
to perform interviews and obtain records and/or other relevant
documentation.
If you reside near Miami, Orlando, Tampa, FL area, -you will enjoy
the flexibility to telecommute* as you take on some tough
challenges.
Primary Responsibilities:
Assess complaints of alleged misconduct received within the
Company
Investigate medium to highly complex cases of fraud, waste and
abuse
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 summaries
of the findings
Participate in settlement negotiations and/or produce investigative
materials in support of the later
Communicate effectively, to include written and verbal forms of
communication
Develop goals and objectives, track progress and adapt to changing
priorities
Collect, collate, analyze and interpret data relating to fraud,
waste and abuse referrals
Ensure compliance of applicable federal/state regulations or
contractual obligations
Report suspected fraud, waste and abuse 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 SIU
leadership, to include attendance at work-groups or regulatory
meetings
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 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 or associate degree plus 2 years of equivalent
work experience with healthcare related employment
2+ years of experience in health care fraud, waste and abuse (FWA)
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2+ years of experience in state or federal regulatory FWA
requirements
2+ years of experience analyzing data to identify fraud, waste and
abuse trends -
2+ years of experience using Microsoft Excel and Word -
Intermediate level of knowledge in pharmacy claims processing
Reside in the state of Florida
Ability to travel up to 50% within FL
Access to reliable transportation & valid US driver's license
Must participate in legal proceedings, arbitration, and depositions
at the direction of management
Preferred Qualifications:
National Health Care Anti-Fraud Association (NHCAA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)
License and/or Certified Pharmacy Technician (CPhT)
2+ years of experience in health care policies, procedures, and
documentation standards
2+ years of experience in developing investigative strategies
Operational experience with a pharmacy and/or pharmacy benefits
manager (PBM)
Specialized knowledge/training in healthcare FWA investigations
*All Telecommuters will be required to adhere to UnitedHealth
Group's Telecommuter Policy.
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The salary range for this role is $59,500 -to $116,600 -annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives. -
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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.
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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.
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UnitedHealth Group -is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
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#RPO, #RED
Keywords: UnitedHealthcare, Tamiami , Field Based Senior Investigator in Florida, Other , Miami, Florida
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