Investigator - National Remote

4 weeks ago

Houston, United States Unitedhealth Group Full time
At UnitedHealthcare, were 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 Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The Investigator is responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:Assess complaints of alleged misconduct received within the CompanyInvestigate low to medium complex cases of fraud, waste and abuseDetect fraudulent activity by members, providers, employees and other parties against the CompanyDevelop and deploy the most effective and efficient investigative strategy for each investigationMaintain accurate, current and thorough case information in the Special Investigations Units (SIUs) case tracking systemCollect and secure documentation or evidence and prepare summaries of the findingsParticipate in settlement negotiations and/or produce investigative materials in support of the laterCollect, collate, analyze and interpret data relating to fraud, waste and abuse referralsEnsure compliance of applicable federal/state regulations or contractual obligationsReport suspected fraud, waste and abuse to appropriate federal or state government regulatorsComply with goals, policies, procedures and strategic plans as delegated by SIU leadershipCollaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetingsCommunicate effectively, to include written and verbal forms of communicationDevelop goals and objectives, track progress and adapt to changing prioritiesYoull 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:Associate's Degree (or higher) and 2+ years of experience in healthcare related employmentBasic level of knowledge OR 2+ years of experience in health care fraud, waste, and abuse (FWA)Basic level of knowledge OR 2+ years of experience in state or federal regulatory FWA requirementsBasic level of knowledge OR 2+ years of experience in analyzing data to identify fraud, waste and abuse trendsBasic level of proficiency OR 2+ years of experience in Microsoft Excel and WordAbility to participate in legal proceedings, arbitration, and depositions at the direction of managementPreferred Qualifications:Demonstrated basic level of knowledge in health care policies, procedures, and documentation standards or minimum of 2 years of experience or lessDemonstrated basic level of skills in developing investigative strategies or 0-2 years of experienceSpecialized knowledge/training in healthcare FWA investigationsActive Affiliations: National Health Care Anti-Fraud Association (NHCAA) or Accredited Health Care Fraud Investigator (AHFI)Certified Fraud Examiner (CFE)Certified Professional Coder (CPC)Medical Laboratory Technician (MLT) DataLicense and/or Certified Pharmacy Technician (CPhT)*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii or Washington Residents Only : The salary range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, or Washington residents is $48,300 to $94,500 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, youll 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 everyoneof every race, gender, sexuality, age, location, and incomedeserves 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 Groupis a drug - free workplace. Candidates are required to pass a drug test before beginning employment.#RPO #GREEN#J-18808-Ljbffr

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