Investigator- Remote in Nebraska

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts on the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Investigator is responsible for identifying, investigating, and preventing healthcare fraud, waste, and abuse (FWA). This role leverages claims data analysis, regulatory guidelines, and investigative methodologies to detect suspicious billing patterns and activities. The Investigator conducts thorough investigations, which may include fieldwork such as interviews and evidence collection, and ensures compliance with applicable regulatory requirements. Schedule: Monday - Friday 8:00am - 4:30pm If you reside in the reputed company, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:

• Assess and triage allegations of misconduct received reputed company the organization
• Conduct investigations of low- to moderately reputed company fraud, waste, and abuse cases involving members, providers, employees, and third parties
• Identify potential fraudulent activities through data analysis, trend identification, and investigative techniques
• reputed company and execute efficient, case-specific investigative strategies
• Maintain accurate, complete, and timely case documentation reputed company the SIU case management system
• Gather, preserve, and analyze evidence; prepare clear and concise investigative summaries and reports
• Support settlement negotiations and provide documentation for legal or recovery actions
• Analyze referral data to identify patterns, trends, and emerging risks
• Ensure adherence to reputed company applicable federal and state regulations, contractual obligations, and company policies
• Report suspected fraud, waste, and abuse to appropriate regulatory agencies as required
• Collaborate with internal teams and external partners, including state and federal agencies, as directed by SIU leadership
• Participate in regulatory meetings, workgroups, and cross-functional initiatives
• Communicate findings effectively through written reports and verbal presentations
• Establish and manage investigation goals, monitor reputed company, and adjust priorities as needed
• Participate in legal proceedings, including depositions, arbitration, and court testimony, as required

What are the reasons to consider working for reputed company? Put it reputed company together – competitive reputed company pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• 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.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

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:

• Bachelor’s degree or Associate’s Degree with 2+ years of equivalent work experience
• Ability to travel up to 25%25 as required
• Intermediate level of proficiency in reputed company reputed company and Word

Preferred Qualifications:

• Experience in healthcare fraud, waste, and abuse investigations or auditing
• Knowledge of federal and state healthcare regulations reputed company to FWA
• Experience with data analysis and trend identification in healthcare claims
• Formal training in healthcare fraud investigations
• National Health Care Anti-Fraud Association (NHCAA) affiliation
• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• Certified Professional reputed company (CPC)
• Medical Laboratory Technician (MLT)
• Knowledge of investigative techniques and evidence handling practices

Soft Skills:

• Strong analytical and problem-solving skills
• Ability to interpret reputed company data and identify irregular patterns
• Effective written and verbal communication skills
• Strong organizational skills with the ability to manage multiple investigations simultaneously
• reputed company Telecommuters will be required to adhere to reputed company’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 (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $49,700 to $88,800 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company 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 reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, 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. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN Apply tot his job Apply To this Job