Investigator - Remote Nationwide - Houston, United States - UnitedHealthcare

UnitedHealthcare

Verified Company

Houston, United States

1 day ago

Posted by:

Mark Lane

beBee recruiter

Description

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
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.

You'll 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 Company
Investigate low to medium complex cases of fraud, waste and abuse
Detect fraudulent activity by members, providers, employees and other parties against the Company
Develop and deploy the most effective and efficient investigative strategy for each investigation
Maintain accurate, current and thorough case information in the Special Investigations Unit's (SIU's) case tracking system
Collect and secure documentation or evidence and prepare summaries of the findings
Participate in settlement negotiations and/or produce investigative materials in support of the later
Collect, collate, analyze and interpret data relating to fraud, waste and abuse referrals
Ensure compliance of applicable federal/state regulations or contractual obligations
Report suspected fraud, waste and abuse to appropriate federal or state government regulators
Comply with goals, policies, procedures and strategic plans as delegated by SIU leadership
Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at workgroups or regulatory meetings
Communicate effectively, to include written and verbal forms of communication
Develop goals and objectives, track progress and adapt to changing priorities

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:

Associate's Degree (or higher) AND 2+ years of experience with healthcare related employment
Basic 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 requirements
Basic level of knowledge OR 2+ years of experience in analyzing data to identify fraud, waste and abuse trends
Basic level of proficiency OR 2+ years of experience in Microsoft Excel and Word
Ability to travel up to 20% locally
Ability to participate in legal proceedings, arbitration, and depositions at the direction of management

Preferred Qualifications:

Demonstrated basic level of knowledge in health care policies, procedures, and documentation standards or minimum of 2 years of experience or less
Demonstrated basic level of skills in developing investigative strategies or 02 years of experience
Specialized knowledge/training in healthcare FWA investigations
Active 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) Data
If applicable
Basic knowledge and experience in any of the following: Statistical Analysis Software (SAS), R, Python, Tableau, Toad, Structured Query Language (SQL), Visual Basic for Applications (VBA), Alteryx
Basic knowledge and experience in any of the following: Statistical Analysis, Regression Analysis, Linear Analysis, Marketbasket Analysis Pharmacy
If applicable
License and/or Certified Pharmacy Technician (CPhT)
Basic knowledge in pharmacy claims processing
Operational experience with a pharmacy and/or pharmacy benefits manager (PBM)
All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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 o