Senior Investigator

Optum 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.   

If reside in Tennessee, you will have the flexibility to work remotely* as you take on some tough challenges. 

Primary Responsibilities:

• Gather and analyze data and information gathered to determine behavior and understand provider/scheme at issue
• Utilize appropriate documentation and tracking controls in the case tracking system to ensure compliance and auditability requirements are met
• Collaborate with clinical coding consultant to apply knowledge of coding guidelines to determine validity of aberrances (SIU only)
• Gather all relevant facts to articulate behavior through an Investigation Summary and compliance package.  Communicate clear rationale for investigation processes and outcomes to Client, Regulator and stakeholders
• Collaborate with a variety of external sources to identify current and emerging patterns and schemes related for FWA to ensure additional TIP submission
• Perform member and provider interviews, and review medical documentation as needed
• Communicate with legal, Law Enforcement, clients and business partners as needed

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.

%3Cp class=%22MsoNormal%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Cstrong%3ERequired Qualifications:%3C/strong%3E%3C/span%3E%3C/p%3E%3Cul style=%22margin-top:0in;%22 type=%22disc%22%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EHigh School Diploma/GED%26nbsp;%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E5+ years of experience working in a FWA / SIU or Fraud investigations role for Tennessee location%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E2+ years of experience within the health insurance claims industry%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E2+ years of experience working with law enforcement or legal entities or 3+ years of Investigative experience with fraud investigations%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E1+ years of knowledge and/or experience with behavioral health codes and service delivery%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EIntermediate level of proficiency in Microsoft Excel (pivot tables and macros) and Word (documents)%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EAbility to travel 25% of the time in the state of Tennessee for client on-site visits%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EReside in the state of Tennessee%3C/span%3E%3C/li%3E%3C/ul%3E%3Cp class=%22MsoNormal%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Cstrong%3EPreferred Qualifications:%3C/strong%3E%3C/span%3E%3C/p%3E%3Cul style=%22margin-top:0in;%22 type=%22disc%22%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EProfessional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EExperience with computer research%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EExperience with regulatory compliance%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EExperience with data analysis as it relates to financial recovery/settlements%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EFamiliar with CPT code terminology%3C/span%3E%3C/li%3E%3C/ul%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%26nbsp; %26nbsp;%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22background-color:inherit;color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Cspan class=%22TextRun SCXO137179324 BCX0 NormalTextRun%22 style=%22-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:none !important;font-weight:400;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-align:left;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;user-select:text;white-space:normal;widows:2;word-spacing:0px;%22 data-contrast=%22auto%22 xml:lang=%22EN-US%22 lang=%22EN-US%22%3EPay 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 %3C/span%3E%3Cspan class=%22TextRun SCXO137179324 BCX0 NormalTextRun%22 style=%22-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:none !important;font-weight:normal;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-align:left;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;user-select:text;white-space:normal;widows:2;word-spacing:0px;%22 data-contrast=%22auto%22 xml:lang=%22EN-US%22 lang=%22EN-US%22%3Erange%3C/span%3E%3Cspan class=%22TextRun SCXO137179324 BCX0 NormalTextRun%22 style=%22-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:none !important;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-align:left;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;user-select:text;white-space:normal;widows:2;word-spacing:0px;%22 data-contrast=%22auto%22 xml:lang=%22EN-US%22 lang=%22EN-US%22%3E%3Cstrong%3E %3C/strong%3E%3C/span%3E%3Cspan class=%22TextRun SCXO137179324 BCX0 NormalTextRun%22 style=%22-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:none !important;font-weight:400;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-align:left;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;user-select:text;white-space:normal;widows:2;word-spacing:0px;%22 data-contrast=%22auto%22 xml:lang=%22EN-US%22 lang=%22EN-US%22%3Efrom %2460,200 to %24107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.%3C/span%3E%3C/span%3E%3Cspan style=%22background-color:rgb(255,255,255);color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Cspan class=%22EOP SCXO137179324 BCX0%22 style=%22-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-align:left;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;user-select:text;white-space:normal;widows:2;word-spacing:0px;%22%3E%26nbsp;%3C/span%3E%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%26nbsp; %26nbsp;%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Ci%3E%3Cspan style=%22line-height:10.7px;%22%3EAt 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.%3C/span%3E%3C/i%3E%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%26nbsp; %26nbsp;%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%26nbsp; %26nbsp;%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Ci%3EUnitedHealth 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.%3C/i%3E%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Ci%3E%26nbsp; %26nbsp;%26nbsp;%3C/i%3E%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Ci%3EUnitedHealth Group%26nbsp;is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.%3C/i%3E%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Ci%3E%26nbsp; %26nbsp;%26nbsp;%3C/i%3E%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:center;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E%3Ci%3E%26nbsp; %26nbsp;%3C/i%3E%3C/span%3E%3C/p%3E%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%3E%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3E#RPO #GREEN%3C/span%3E%3C/p%3E

Job Details
Job: Special Investigation Unit
Primary Location: US-TN-Nashville
Organization: Ops Payer Payment Integrity
Schedule: Full-time
Number of Openings: 1