Senior Investigator

Requisition Number: 2367121
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 will be responsible for investigating agent/broker complaints across all lines of business in accordance with state and federal regulations.
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:

• Conduct confidential compliance investigations related to Agents/Brokers across all lines of business
• Document all relevant findings in written reports
• Utilize information from plan members (interviews), agents/brokers, sales operations, claims data and internal systems
• Conduct and document interviews (on telephone and in person) for all parties involved in an investigation
• Report on any illegal activities in accordance with all laws and regulations
• Act as a subject matter expert with identifying and communicating relevant findings to the business
• Where applicable, provide testimony regarding the investigation
• Responsible for generating independent work products

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:

• High School Diploma/GED
• 3+ years of Investigative experience
• 2+ years of healthcare related experience
• Advanced level of proficiency with communicating complex information both verbally and in written form
• Intermediate level of knowledge of Local, State & Federal laws and regulations pertaining to Affordable Care Act Plans
• Intermediate level of proficiency in MS Office Suite Products (Excel and Word)

Preferred Qualifications:

• Fraud Certification, such as CFE of AHFI
• Experience directly in Healthcare/Insurance related Compliance, Investigations or Operations
• Experience using internal systems including Facets, Doc360, Maestro, Alvar
• Intermediate level knowledge of Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, and/or commercial health insurance)

*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.
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