Senior Investigator

• Assess complaints of alleged misconduct received within the Company
• Investigate medium to high 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
• 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 workgroups or regulatory meetings
• Communicate effectively including written and verbal forms of communication
• Develop goals and objectives track progress and adapt to changing priorities
• Must participate in legal proceedings arbitration and depositions at the direction of management

• 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.)

• Associate's degree or above
• 2+ years of experience in fraud waste and abuse (FWA) investigations/audit
• 2+ years of experience with state/federal laws and regulations pertaining to healthcare FWA
• 2+ years of experience in analyzing data to identify fraud waste and abuse trends
• Intermediate level of proficiency in Microsoft Excel and Word
• Ability to travel up to 50% a ccess to reliable transportation and & valid US driver's license
• Reside in the state of New Mexico

• Specialized knowledge/training in healthcare FWA investigations
• Active affiliations with the National Health Care Anti-Fraud Association (NHCAA)
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• Certified Professional Coder (CPC)
• Medical Laboratory Technician (MLT)
• Statistical Analysis

What We Do

Optum part of the UnitedHealth Group family of businesses is a global organization that delivers care aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care pharmacy benefits data and resources they need to feel their best. Here you will find a culture guided by inclusion talented peers comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. At Optum we support your well-being with an understanding team extensive benefits and rewarding opportunities. By joining us you’ll have the resources to drive system transformation while we help you take care of your future. We recognize the power of connection to drive change improve efficiency and make a difference in health care. Join a team where your skills and ideas can make an impact and where collaboration is key to creating technology that produces healthier outcomes.

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