Director of Fraud and Abuse Growth and Ideation – Remote

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.  

The Optum, Fraud and Abuse organization is an integral part of detecting, correcting and monitoring of provider centric behavior with a mission to reduce member harm and risk to the clients we serve.  

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Create and successfully implement a growth strategy for the Fraud and Abuse organization to meet a 20% improvement in medical cost savings with internal analytic opportunity and new client implementation
• Manage and monitor a portfolio of 70+ analytic concepts including providing insights for true positive rate and analytic performance improvement with a medical cost savings goal of $75M per year
• Collaborate and influence internal product, finance, analytic and operational teams to ensure alignment of strategy, timing of implementation, and forecasting of operational impact to meet implementation and savings goals
• Negotiate and manage the development of all external client contracts to ensure organizational return on investment goals are met
• Prepare and present client marketing collateral while representing the best interests of Optum and the Fraud and Abuse organization
• Manage a team of Sr. Fraud Investigators through a consulting value stream to meet external client KPIs, contract expectations with a goal of market leading Net Promotor Scores
• Improve turnaround time for analytic ideation through deployment by 15% by creating a standardized process across the client portfolio
• Perform advanced ideation to identify potential FWA concepts or schemes
• Collaboratively work with internal teams to manage expectations, lead without authority to ensure client and implementation goals are met
• Act as a subject matter expert and first point of contact to the client for all analytic concepts by preparing and presenting all required documentation for approval, status and performance
• Create and maintain a forecasting plan to ensure financials, capacity planning and work force capacity is aligned to ensure compliance with service level agreements and key performance indicators are met
• Engage with the internal production staff within the business to ensure understanding of the concept delivered, investigation support and outcome guidance through policy and procedure communication and delivery/training
• Ability to communicate KPI and strategic progress to clients, Sr. Leadership and internal partners
• Set and direct performance in a matrix environment and provide direction without influence
• Set yearly goals for internal business units
• Create, implement and drive the business strategy for improvements within the analytic delivery of the creation, testing and implementation of new analytic concepts

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:

• 5+ years of experience within a Special Investigation Department
• 5+ years of experience as a certified fraud examiner with an active AHFI Certification
• 4+ years of experience working in a role where you had to influence others without direct authority 
• 3+ years in a law enforcement or medical fraud and abuse investigative experience
• 3+ years of experience leading people
• 3+ years of experience in healthcare operations, including experience with performance metrics, measurements and data analysis
• 3+ years of SIU Consulting experience managing a portfolio of clients with contract negotiation and new client implementation
• Experience working with Microsoft Office including Word, Power Point and Excel (creating documents, presentations, excel formulas, pivot tables, charts)
• Proven ability to present facts/recommendations in effectively in oral and written form
• Proven ability to interact one-on-one and consult with all levels of leadership
• Proven ability to travel up to 10% as needed

Preferred Qualifications:

• MACRO, RPAs and SharePoint experience 
• Experience writing policies and procedures and job aids
• Basic knowledge and experience in finance (budgeting) and cost accounting

*All employees working remotely will be required to adhere to UnitedHealth Group’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 (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 range from $132,200 to $226,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.