- Investigate medium to highly 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
- Communicate effectively, to include written and verbal forms of communication
- Develop goals and objectives, track progress and adapt to changing priorities
- 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 work-groups or regulatory meetings
- Associates Degree (or higher) AND 2+ years of equivalent work experience with healthcare related employment
- 2-5 years of experience OR a demonstrated intermediate level of knowledge in health care fraud, waste and abuse (FWA)
- 2-5 years of experience OR a demonstrated intermediate level of knowledge in state or federal regulatory FWA requirements
- 2-5 years of experience OR a demonstrated intermediate level of knowledge analyzing data to identify fraud, waste and abuse trends
- 2-5 years of experience OR a demonstrated intermediate level of proficiency in Microsoft Excel and Word
- Ability to participate in legal proceedings, arbitration, and depositions at the direction of management
- Currently reside within the state of Louisiana or has the ability to relocate at their own expense
- Ability to travel up to 25% of the time
-
Senior Investigator
3 days ago
UnitedHealth Group Baton Rouge, United StatesInvestigate medium to highly 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 Investigator, Senior, Health, ...
-
Senior Investigator
1 day ago
UnitedHealth Group Baton Rouge, United StatesLocation field must contain 'city, state' or a zip code to perform a radius search (e.g., Denver, CO or City and state must be separated by a comma followed by a space (e.g., Houston, TX )At UnitedHealthcare, were simplifying the health care experience, creating healthier communi ...
-
Senior Investigator
2 days ago
UnitedHealth Group Baton Rouge, United StatesLocation field must contain 'city, state' or a zip code to perform a radius search (e.g., · Denver, CO · or · City and state must be separated by a comma followed by a space (e.g., · Houston, TX ) · At UnitedHealthcare, we're simplifying the health care experience, creating h ...
-
SIU Senior Investigator
2 weeks ago
CVS Pharmacy, Inc. Baton Rouge, United StatesAs a Senior Investigator you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those that are national in scope, complex cases involvi Investigator, Senior, Healthc ...
-
Senior Investigator
3 weeks ago
UnitedHealth Group Baton Rouge, United StatesAt 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 respo ...
-
Senior Investigator
3 weeks ago
UnitedHealth Group Baton Rouge, United StatesAt 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 resp ...
-
Senior Archaeologist/Principal Investigator
3 weeks ago
Gulf South Research Baton Rouge, United StatesThis position is : Full Time · Gulf South Research Corporation (GSRC) is a fast-growing, certified woman-owned small business offering multidisciplinary, environmental and cultural resources services to Government and corporate clients throughout the United States. · We are see ...
-
Senior Archaeologist/Principal Investigator
3 days ago
Gulf South Research Baton Rouge, United StatesThis position is : Full TimeGulf South Research Corporation (GSRC) is a fast-growing, certified woman-owned small business offering multidisciplinary, environmental and cultural resources services to Government and corporate clients throughout the United States.We are seeking a f ...
-
Human Resources Director
3 weeks ago
4th Sector Solutions Inc. Baton Rouge, United StatesJob Summary: · The Director of Human Resources is the lead human resource partner for 4th Sector Solutions and serves as an advocate regarding benefits, policies, and practices that would have a positive impact on employees and as an advisor and strategic partner to senior manage ...
-
Human Resource Business Partner
1 hour ago
Amentum Baton Rouge, United States Full timeAs an HR Business Partner, you will be a strategic advisor to leadership and a vital resource for team members. Your role will encompass supporting onboarding, performance management, and providing essential guidance to ensure the success of both leaders and team members. You'll ...
-
Senior Chemical Process Engineer
1 week ago
Exxon Mobil Baton Rouge, United StatesAbout us · At ExxonMobil, our vision is to lead in energy innovations that advance modern living and a net-zero future. As one of the world's largest publicly traded energy and chemical companies, we are powered by a unique and diverse workforce fueled by the pride in what we do ...
-
Senior Chemical Process Engineer
2 weeks ago
ExxonMobil Corporation Baton Rouge, United StatesWhat you will do · Serve as the technical leader on the business team by: Mentoring less experienced engineers on design practices, unit health monitoring, and troubleshooting Provide off-hours support of abnormal and non-routine operations, including unit Turnarounds Aiding in ...
-
Senior Chemical Process Engineer
2 weeks ago
ExxonMobil Baton Rouge, United StatesAbout us · At ExxonMobil, our vision is to lead in energy innovations that advance modern living and a net-zero future. As one of the world's largest publicly traded energy and chemical companies, we are powered by a unique and diverse workforce fueled by the pride in what we do ...
-
Senior Process Control Applications Engineer
3 weeks ago
Exxon Mobil Baton Rouge, United StatesAbout us · At ExxonMobil, our vision is to lead in energy innovations that advance modern living and a net-zero future. As one of the world's largest publicly traded energy and chemical companies, we are powered by a unique and diverse workforce fueled by the pride in what we do ...
-
Research Associate 3
2 weeks ago
Louisiana State University Healthcare Network: New Orleans Baton Rouge, United StatesThe Research Associate 3 (RA3) will plan, assist, and conduct highly independent research, upon approval of the Principal Investigator, studying glioblastomas. The RA3 will monitor and maintain all in vivo experiments. Manage and perform lab operations including daily and routine ...
-
Process Safety Engineer
2 weeks ago
Ambs Chemical Search LLC Baton Rouge, United StatesServe as the Senior Process Safety Engineer for a petrochemical plant in the East Baton Rouge area. Engineers love working with this process and its diverse unit operations. You will manage the PSM Program and the Risk Management Program. The site has a variety of process hazards ...
-
Digital Forensic Analyst
3 weeks ago
IronGate Cybersecurity LLC Baton Rouge, United StatesJob Description · Job DescriptionIronGate Cybersecurity is seeking a motivated and detail-oriented Digital Forensics Analyst to join our Professional Services Team. This role is ideal for someone passionate about cybersecurity, eager to learn, and looking to make a significant im ...
-
Human Resources Director
17 hours ago
4th Sector Solutions Baton Rouge, United StatesJob Summary: · The Director of Human Resources is the lead human resource partner for 4th Sector Solutions and serves as an advocate regarding benefits, policies, and practices that would have a positive impact on employees and as an advisor and strategic partner to senior manag ...
-
Entry Level Transportation Design Engineer
2 weeks ago
Stanley Consultants Baton Rouge, United StatesStanley Consultants is currently seeking a talented Entry Level Transportation Design Engineer with 0-2 years of experience looking to pursue a career in transportation design engineering in our Baton Rouge, LA office. The successful candidate will have the opportunity to gain ex ...
-
Senior Digital Forensic Analyst
3 weeks ago
IronGate Cybersecurity LLC Baton Rouge, United StatesJob Description · Job DescriptionIronGate Cybersecurity is in search of a highly skilled and experienced Senior Digital Forensics Analyst to enhance our Professional Services Team. This critical role is designed for a cybersecurity expert who is deeply passionate about cyber defe ...
Senior Investigator - Baton Rouge, United States - UnitedHealth Group
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 and start doing your life's best work.SM
The Senior Investigator reports directly to the Manager of Investigations. The Senior Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Senior Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Senior 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 Louisiana as you take on some tough challenges.
Primary Responsibilities:
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:
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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.
#RPO
