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.

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