Senior Investigator - Dental

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 reports directly to the Manager of Investigations. 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 position will be designated to work all fraud and abuse investigations related to the Texas Children's Medicaid and Texas Children's Health Insurance CHIP dental programs. The Senior Investigator is responsible to conduct investigations which may include field work 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. Primary Responsibilities:

• 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 latter
• Research, query, analyze and interpret data pertaining to dental claims and fraud, waste and abuse of dental claims
• 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

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 Associates degree plus 2+ years of equivalent work experience with healthcare related employment
• Hold the designation of Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) OR have at least 3 years of prior Medicaid/CHIP fraud, waste and abuse investigatory experience
• Intermediate level of proficiency in Microsoft Excel and Word
• Intermediate level of knowledge and experience in health care (including dental) fraud, waste and abuse (FWA) investigations
• Intermediate level of knowledge with local, state/federal laws and regulations pertaining to healthcare fraud, waste and abuse (FWA)
• Ability to travel up to 25%

Preferred Qualifications:

• Specialized knowledge/training in healthcare FWA investigations
• Active affiliation with National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Licensed Dentist
• Certified Fraud Examiner (CFE)
• Certified Professional Coder (CPC)
• Certified Dental Coder (CDC)
• Registered Dental Hygienist
• Ability to develop goals and objectives, track progress and adapt to changing priorities
• Average skills in data manipulation
• Average skills in developing investigative strategies
• Ability to participate in legal proceedings, arbitrations, depositions, etc.
• Ability to develop goals and objectives, track progress and adapt to changing priorities
• 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 $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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. #RPO #GREEN Apply tot his job Apply To this Job