Director of Investigations
What makes your Compliance career greater with UnitedHealth Group? Growth opportunities with the potential to impact the health care system ensure it will always be challenging and exciting. The Director, Investigations will be responsible for leading a team that is triaging, investigating and resolving instances of healthcare fraud and/or abusive conduct by the medical profession, insured members or the broker community. This team will be utilizing information from claims data analysis, plan members, the medical community and law enforcement, employee's conduct confidential investigations and document relevant findings. They will report any illegal activities in accordance with all laws and regulations. The Director may also conduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation. They will act as a subject matter expert with identifying, communicating and recovering losses as deemed appropriate. Where applicable they will provide testimonials regarding the investigation.
The Director of Investigations, Health Services is responsible for providing oversight, direction and practical leadership for Health Services compliance and privacy investigations program as well as for leading or conducting certain investigations. Specifically, this position is accountable for continued operational development and oversight of Health Service's compliance and privacy investigations standards and activities, leading and providing ongoing education and mentoring to compliance investigative staff across the services businesses, leading or personally conducting certain investigations and ensuring coordination of investigative activities, and collaborating with Legal and Compliance staff to drive business response to operational recommendations based on investigative findings. The Director of Investigations reports to the Health Services Chief Compliance Officer and works collaboratively with other key legal, compliance and privacy leaders both within Health Services OptumHealth, OptumInsight and OptumRx and within UnitedHealth Group more broadly, including its benefits and enterprise investigations leaders.
Major Responsibilities of Position:
This position leads, and directs, Health Service's compliance and privacy investigations strategy, program and activities to ensure effective, appropriate and timely investigations of reports of potential non-compliance across the Services businesses. This position is also responsible for conducting certain investigations, developing and presenting ongoing training and education for individuals across Health Services who conduct compliance and privacy investigations, and for ensuring appropriate documentation, trending, and reporting on investigative activities and results. Activities include:
Investigations Program.
-Establishing or enhancing Health Services-wide investigation standards and procedures - ensuring alignment with enterprise policies and standards;
-Coordinating with the Segment Compliance Officers for the Health Services businesses to align investigative practices and ensure investigative standards are met;
-Collaborating with Health Services business segment Legal, Compliance and Privacy Officers and with Enterprise Investigations leaders to identify and drive implementation of best practices relating to investigation standards and processes across Health Services;
-Designing, implementing, trending and reporting Health Services-wide metrics to assess performance, investigative results and trends, and to identify investigation practice improvement opportunities;
Investigations
-Leading complex investigations and coordinating with internal partners to ensure effective and timely investigations;
-Collaborating and coordinating with other enterprise investigative staff on investigations that cross segments and require alignment and cooperation for investigation strategy, activities and results;
-Overseeing management and reporting of compliance and privacy complaint investigations across Health Services and tracking implementation of corrective actions;
-Coordinating with Health Services Legal and business segment Compliance and Privacy Officers to ensure that Health Services business segments maintain appropriate documentation of investigation activities, results, recommendations and any required corrective action.
-Collaborating with Health Services Legal to investigate and address attorney-client privileged reviews relating to reports of potential non-compliance;
-Collaborating with Health Services Legal and the business segment Compliance and Privacy Officers to provide recommendations for operational enhancements based on investigative results and findings;
Training and Development
-Facilitating the development of training, awareness and communication of investigation standards and expectations across Health Services investigative staff;
-Identifying and ensuring appropriate mentoring or other developmental opportunities as part of ongoing development plan for investigative staff;
-Coordinating with Enterprise Training Council and/or business segment Compliance Officers and investigative staff to ensure effective targeted training and communication relating to investigative findings and recommendations where appropriate; and
-Collaborating with enterprise investigative staff as appropriate to develop and align enterprise training on investigation standards, technique, and case management.
Qualifications for Position:
Minimum 10 years of experience as an investigator with law enforcement or healthcare fraud experience, with proven history of successful results in managing complex investigations and oversight and development of investigative staff. Other qualifications include:
-Demonstrated breadth and depth of knowledge of investigation best practices and related legal/regulatory and issues;
-Knowledge of investigatory methodologies and tools, including ability to identify and manage investigation resources,
-Health care industry experience preferred;
-Adept at understanding complex concepts and situations presented by the business environment;
-Ability to assess complex problems and recommend the appropriate compliance solutions;
-Objective, collaborative approach;
-Demonstrated ability to lead and influence in a large, matrixed organization;
-Demonstrated ability to think strategically and to proactively manage implementation of broad-based as well as specific initiatives;
-Ability to adapt in a dynamic and high-growth environment;
-Exceptional written, verbal, analytical, organizational, problem solving and presentational skills;
-Law Enforcement experience preferred, but not required.
Requirements:
- Undergraduate degree required in the area of Criminal Justice or related field.
- 8+ years of experience with law enforcement investigation.
- 6+ years of experience with the group health business
- 2+ years of experience in developing and executing on complex business plans.
- 3+ years of investigative management experience (prefer law enforcement experience) of ten or more staff.
- Experience managing a budget.
- Strong communication and negotiation skills.
- Intermediate level of proficiency with MS Word and Excel
UnitedHealth Group is working to create the health care system of tomorrow.
Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.
Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.
Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.
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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.