Job Description

Opportunities at Change Healthcare , part of the Optum family of businesses. We are transforming the health care system through innovative technology and analytics. Find opportunities to make a difference in a variety of career areas as we all play a role in accelerating health care transformation. Help us deliver cutting-edge solutions for patients, hospitals and insurance companies, resulting in healthier communities. Use your talents to improve the health outcomes of millions of people and discover the meaning behind: Caring. Connecting. Growing together.

The Payments Fraud Investigator will conduct in depth investigations into complex incidences of suspected or confirmed fraudulent activity, thoroughly document and present findings, conduct root cause analysis, and engage with key stakeholders on investigative actions and risk mitigation.

Primary Responsibilities:

• Drives investigations by gathering all relevant data and facts such as verifications, research, records, and interviews, determines relevance and applicability to the investigation, and develops/communicates findings
• Conducts and participates in discussions with key internal and external stakeholders as the subject matter expert (SME); such as providers, customers, clients/payers, executive leadership, legal and compliance, privacy, enterprise security, etc.
• Participates in legal proceedings, as required
• Communicates facts and findings effectively, both verbally and in writing, with confidence as a subject matter expert
• Apply deep knowledge of investigative processes and best practices to:
• Develop investigative plans and procedures for the fraud operation; conducts reviews and monitors for compliance
• Manage and prioritize investigative assignments and case loads to meet deadlines, SLAs and business requirements
• As the investigative SME, reviews the work of others to recommend next steps, share best practices and ensure compliance with outlined policies and procedures
• Respond to internal and external stakeholder requests and/or concerns (i.e.. Privacy, Legal, Law Enforcement, business owner, provider/payer, etc.)
• Provide ongoing reporting and analysis of investigation to all applicable stakeholders, as needed
• Documents and reports financial impact of investigation outcomes (e.g., losses, savings, recoveries)
• Conducts complex analyses of case facts, findings, data and trends; utilizes results to initiate corrective actions, establish new or revised monitoring and strategy, and drive automation
• Recommends systems, tools and processes to improve the fraud operation and mitigate risk
• Ensure Compliance with Applicable Laws, Regulations and Guidelines
• Ensure compliance with applicable laws and regulations (e.g., HIPAA, CMS, PPACA, state-specific regulations)
• Adhere to applicable contractual requirements (e.g., provider/payer/client contracts)
• Complete legally mandated training requirements

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:

• 4+ years of investigations experience as a law enforcement or corporate investigator, conducting complex investigations in financial fraud, economic crimes, organized retail crime, or similar major crimes investigative capacity
• Experience communicating verbally with subjects, victims, witnesses and other involved parties to obtain relevant facts
• Experience in interpreting data from bank and/or identity validation tools and services, public records databases, open-source techniques, etc. to verify data relevant to the investigation

Preferred Qualifications:

• Professional certification, such as CFE or CFCI, or other relevant certification
• Payments and/or healthcare investigations or risk management experience
• Ability to be comfortable working in a fast-paced, growing environment; ability to pivot and change as business needs demand; can do, growth mindset
• Ability to work independently and demonstrate integrity to promote trust and accountability in a remote work environment
• Ability to effectively communicate findings with attention to detail in professionally written investigations case reports as well as verbally, to stakeholders and/or in legal proceedings
• Demonstrated confidence in ability to learn new processes, systems, and tools to achieve proficiency in independently obtaining relevant information for investigative purposes
• End user proficiency with data analysis tools such as Tableau or PowerBI

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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.

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