Senior SIU Analyst

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

UMR, UnitedHealthcare's third-party administrator (TPA) solution, is the nation's largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding.

In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.

Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast - paced and highly diversified career. 

The Senior SIU Analyst serves as a proactive fraud intelligence, escalation, and trend analysis specialist responsible for identifying emerging fraud schemes, detecting patterns across claims, providers, and member activity, and generating actionable intelligence that enables early intervention and loss prevention. 

This role leverages data analysis, investigative insights, and business intelligence to uncover fraud risks before payment occurs, supporting SIU through high-risk escalations, investigative lead development, and enterprise-wide fraud mitigation strategies. 

By transforming complex data into proactive detection and prevention opportunities, the Senior SIU Analyst helps drive a forward-looking approach to fraud management that extends beyond traditional investigative activities and focuses on identifying and addressing fraud risks before losses occur.

This position is full-time (40 hours / week). Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 5:00 pm CST. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of paid training. The duration dependent on how quickly you acclimate to role. The hours during training will be 7:00 am - 5:00 pm CST, Monday - Friday. Training will be conducted virtually from your home.  

Primary Responsibilities:

• Monitor claim activity, provider billing patterns, and other data sources to identify anomalies, emerging trends, and potential fraud risks.
• Analyze escalations from internal business partners to determine whether issues are isolated events or indicators of broader fraud schemes.
• Identify emerging trends and patterns that may signal organized, systemic, or high-risk fraud activity.
• Conduct root-cause analyses to understand how fraudulent activity occurs and identify gaps in existing controls and mitigation strategies.
• Develop actionable intelligence to support investigations, provider flagging, claim-edit enhancements, payment prevention efforts, and other fraud mitigation initiatives.
• Collaborate with SIU investigators and cross-functional stakeholders to translate analytical findings into effective fraud prevention and detection actions.
• Quantify avoidance losses resulting from proactive fraud detection, prevention, and intervention efforts.
• Leverage data analytics, investigative methodologies, and industry intelligence to prioritize high-risk activities and focus SIU resources where they can have the greatest impact.
• Prepare and communicate findings, trends, and recommendations to leadership and business partners to support informed decision-making and fraud prevention strategies.
• Support the development and enhancement of fraud detection tools, reporting, and monitoring processes to strengthen proactive fraud identification capabilities.

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:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 2+ years of experience analyzing and solving customer problems in an office setting
• Intermediate level of Microsoft Office including Ms Word, PowerPoint, Outlook, Teams (data entry, sorting/filtering, pivot tables) 
• Ability to work the hours in the job description

Preferred Qualifications:

• 2+ years of current or previous claims processing or claims quality review experience within UMR Claims Processing System (UMR CPS)/ Jacada. (UMR is UnitedHealthcare's third-party administrator (TPA) solution). (You must be an employee of UMR specifically to have experience with the UMR claims system)
• Experience as an SIU Analyst
• Experience as a SME or team lead
• Experience with Fraud, Waste and Abuse review
• Knowledge of Medical Claims Billing, ICD - 10, CPT and / or HCPC codes
• Familiarity with resources such as Knowledge Central and / or UMR Policies and Procedure  

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

*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 hourly pay for this role will range from $24 - $43 per hour 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.