Managing Consultant, Fraud, Waste and Abuse Investigator


Title: Managing Consultant, Fraud, Waste and Abuse Investigator – Telecommute

Location: Eden Prairie Minnesota United States
Division:Advisory Services Payer
Contest Number: 846121
Family: OptumInsight Consulting
Function: Bus Advisory & Tech Cnsltng
BusinessSegment: OptumInsight
Region: North America
Country: United States
City: Eden Prairie
State: Minnesota
EmployeeStatus:Regular
Schedule:Full-time
JobLevel:Director
Shift:Day Job
Travel:No
Overtime Status:Exempt
TelecommuterPosition: Yes

Position Description

As an Investigator with, Optum Advisory Services Payment Integrity you will work in a consulting role providing a broad spectrum of services focusing on health plan Payment Integrity initiatives. The role will drive client value through a range of consulting engagements to assess and improve claims accuracy, identification of fraud, waste and abuse as well as medical cost containment.

This role will develop consulting intellectual property, and consulting offerings associated with the payment integrity practice area. This consulting position will also provide input into the shaping, selling, and delivery of a range of consulting engagements across the payer value chain, in addition to providing market leading services in the Payment Integrity market space.

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

Primary Responsibilities:

  • Perform Fraud, Waste, and Abuse Investigative work for Optum Advisory clients under contract
  • Develop an excellent working relationship with clients, both at the executive and daily operational levels
  • Responsible for delivering on the strategic direction for Optum’s Payment Integrity Advisory services (Consulting) business
  • Participate in the implementation of the strategic plan to meet and exceed financial commitments to clients
  • Project management and implementation
  • Partner with matrixed organizations (e.g. analytics, technology, finance, and human capital, sales) to ensure planned results are delivered
  • Drive plans to exceed client expectations and delight our clients
  • Responsible for attaining critical goals and upholding a high standard of operational performance throughout the teams in assigned organization
  • Work to drive for continuous improvement within the business; past experience driving process improvement initiatives; small scale and large scale is highly desired
  • Support internal and external communication strategy to proactively share with clients the value being driven for them and simultaneously engage the employee base within the business
  • Identify and execute on new opportunities for increases in efficiencies and performance
  • Apply analytical / quantitative approach to problem solving
  • Ability to use and analyze healthcare data; comfortable with statistical concepts
  • Utilize communication skills to influence and negotiate
  • Utilize one’s strong interpersonal skills to work with all levels of management across all functional areas, as well as, business partners through internal entities

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:

  • Bachelor’s degree
  • 10+ years performing FWA investigations for health care payers
  • 3+ years’ experience performing investigative analyses of clinical data to detect FWA
  • Management or lead experience in a Healthplan or Vendor SIU.
  • Experience Expert level of proficiency with problem resolution, collection of relevant health care trend, establishing facts, and drawing valid conclusions
  • Excellent research skills (Internet, statutes, contracts, etc.)
  • Excellent proficiency with Microsoft Office (specifically Word and Excel)
  • Previous large scale project participation (e.g. conceptualized project, sold project, monitored project to successful implementation)
  • Ability to travel up to 25%

Preferred Qualifications:

  • Accredited Healthcare Fraud Investigator (AHFI) credential, through the National Health Care Anti-Fraud Association
  • Certified Fraud Examiner (CFE) credential, through the Association of Certified Fraud Examiners
  • Former law enforcement experience in an investigative capacity
  • Proven ability to produce superior results in a financial performance oriented environment
  • Proven ability to operate in a highly dynamic environment
  • Strong financial analysis and risk management skills
  • Ability to understand and influence the necessary and appropriate actions to ensure maximization of financial results and objectives; a bias for action is critical
  • Excellent written and verbal interpersonal communication skills
  • Excellent time and resource management skills


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