Manager of Investigations

Company: UnitedHealth Group
Location: Minnetonka
Posted on: March 17, 2023

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 and start doing your life's best work.(sm)






The Manager of Investigations reports directly to the Associate Director of Investigations. The Manager of Investigations is responsible for the direct oversight of investigators whose primary roles are: identification, investigation and prevention of healthcare fraud, waste and abuse.






Primary Responsibilities:

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• Managerial oversight of all types of fraud, waste and abuse cases, to include all levels of complexity
  
  
• Ensure compliance with the UnitedHealthcare (UHC) Fraud, Waste and Abuse Program
  
  
• Provide guidance to investigators on effective and efficient investigative strategies
  
  
• Ensure investigators maintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case tracking system
  
  
• Participate in settlement negotiations and/or produce investigative materials in support of the later
  
  
• Collect, collate, analyze and interpret data relating to fraud, waste and abuse referrals
  
  
• Ensure compliance of applicable federal/state regulations or contractual obligations
  
  
• Ensure investigators compliance 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:
  
  
  
  
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  • Bachelor's degree or Associates degree plus two years of equivalent work experience with healthcare related employment
    
    
  • 3+ years of experience working in a government, legal, healthcare, managed care and/or health insurance environment in a regulatory, privacy or compliance/investigative role
    
    
  • Broad knowledge and experience in health care fraud, waste and abuse (FWA) investigations
    
    
  • Broad knowledge and experience in state and federal regulatory FWA requirements
    
    
  • General knowledge of medical benefits, specialty benefits and pharmacy benefits
    
    
  • General knowledge of Compliance Program policies, procedures and documentation standards
    
    
  • Ability to travel
    
    
  • Ability to participate in legal proceedings, arbitrations, depositions, etc.
    
    
  • Advanced level of proficiency in Microsoft Excel and Word
    
    
  • Advanced level of knowledge with local, state/federal laws and regulations pertaining to healthcare fraud, waste and abuse (FWA)
    
    
    
    
    
    
    
    
    Preferred Qualifications:
    
    
    
    
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    • 2+ years of direct supervisory experience
      
      
    • Certified Fraud Examiner (CFE)
      
      
    • Active affiliations:
      
      
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      • National Health Care Anti-Fraud Association (NHCAA)
        
        
        
        
        
        
      • Accredited Health Care Fraud Investigator (AHFI)
        
        
      • Specialized knowledge/training in healthcare FWA investigations
        
        
      • Above average skills in data manipulation
        
        
      • Excellent skills in developing investigative strategies
        
        
      • Demonstrated ability to supervise a team
        
        
      • Demonstrated ability to communicate effectively, to include written and verbal forms of communication
        
        
        
        
        
        
        
        
        Careers with UnitedHealthcare. Work with a Fortune 5 organization that's serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.
        
        
        
        
        
        
        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.
        
        
        
        
        
        
        
        
        
        
        
        Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
        
        
        
        
        
        
        UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, Minnetonka , Manager of Investigations, Executive , Minnetonka, Minnesota