Investigator - Fraud, Waste & Abuse (FWA)

Minneapolis, Minnesota
Feb 17, 2023
Mar 22, 2023
Employment Status
Full Time
Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 600,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.

UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.




UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.


Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 13 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.


Work Location: Work from Home or Office for Your Day

Position Description

As an SIU Investigator, you will be responsible for detecting, preventing, investigating, and correcting alleged or suspected fraud, waste, and/or abuse (FWA) by providers or enrolled members. As an SIU investigator, you will conduct various activities to support UCare's FWA prevention, detection, and correction work.

• Conduct proactive FWA detection and monitoring via various techniques and tools including, but not limited to, data mining and analytics.

• Collaborate with Special Investigations Unit (SIU) Leadership to investigate allegations of FWA.

• Perform analysis of applicable regulations, contracts, and policy manuals to determine whether violations exist.

• Collect, analyze, and document evidence related to FWA investigations and/or projects to include, but not limited to: Conducting and documenting interviews of witnesses or subjects. Perform field work to include provider site visits and surveillance. Compile and organize accurate case file documentation and calculation of potential overpayments. Make referrals of case findings to appropriate law enforcement and/or regulators. Develop investigative summary reports documenting investigative activities and findings.

• Suggest program integrity measures and controls to enhance FWA prevention work.

• Serve as a resource for departments to research and resolve integrity inquiries and assist in identification of improvements to internal practices that may reduce or prevent FWA.

• Represent UCare as a witness in court actions as required, and in affidavits as assigned.

• Support other teams within the Corporate Compliance Department, as assigned.

• Participate in preparing and submitting required reporting to regulatory agencies.

• Respond to data requests submitted by external authorized parties.

• Other projects and duties as assigned.


Bachelor's degree; demonstrated experience may be considered in lieu of degree.

Required Experience

At least two years of experience performing investigations or audits, preferably in health care or fraud. Knowledge of medical terminology. Demonstrated experience using data to perform investigations or audits, including intermediate skill level with Excel.

Preferred Experience

Experience working in a SIU within the health care industry. Knowledge of Medicare and Medicaid.


The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

JOB POST DATE: 2/16/2023

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