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Senior Investigator
3 months ago
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Senior Investigator will be responsible for investigating agent/broker complaints across all lines of business in accordance with state and federal regulations.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Conduct confidential compliance investigations related to Agents/Brokers across all lines of business
- Document all relevant findings in written reports
- Utilize information from plan members (interviews), agents/brokers, sales operations, claims data, and internal systems
- Conduct and document interviews (on telephone and in person) for all parties involved in an investigation
- Report any illegal activities in accordance with all laws and regulations
- Act as a subject matter expert with identifying and communicating relevant findings to the business
- Where applicable, provide testimony regarding the investigation
- Responsible for generating independent work product
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 higher)
- 1+ years of customer service experience
- Basic level of proficiency with Microsoft Word and Excel
Preferred Qualifications:
- Experience with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, Affordable Care Act Plans, and/or commercial health insurance)
- A basic level of knowledge in analyzing data to identify fraud, waste and abuse trends
- Fraud Certification, such as CFE of AHFI
- Experience directly in Healthcare/Insurance related Compliance, Investigations or Operations
- Familiarity within MS Access
- 2+ years of prior Investigative experience
Soft Skills:
- Experience communicating complex information both verbally and in written form
- Excellent verbal and written communication skills
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C Residents Only: The salary range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C residents is $58,300 to $114,300 per year. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
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.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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