UnitedHealthcare
Overview
Senior Investigator-Telecommute Kentucky role at
UnitedHealthcare . 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 conducts investigations which may include field work to perform interviews and obtain records and/or other relevant documentation. Schedule: Monday-Friday Standard Business Hours. You’ll enjoy the flexibility to telecommute from anywhere within the state of
Kentucky
as you take on some tough challenges. Responsibilities
Assess complaints of alleged misconduct received within the company 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 latter Communicate effectively in written and verbal forms 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 with 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 to include attendance at workgroups or regulatory meetings Benefits and Requirements
Required Qualifications
Bachelor's degree OR associate's degree with 3+ years of equivalent work experience in healthcare-related employment 3+ years of experience in healthcare fraud, waste and abuse (FWA) 2+ years of experience in state or federal regulatory FWA requirements 2+ years of experience in analyzing data to identify fraud, waste and abuse trends Intermediate level of proficiency in Microsoft Excel and Word Ability to travel locally (in-state) up to 25% of the time, as needed Ability to participate in legal proceedings, arbitration and depositions at the direction of management Access to reliable transportation and valid US driver’s license Reside in the state of Kentucky Preferred Qualifications
Demonstrated intermediate knowledge of health care policies, procedures and documentation standards or 2-5 years of experience Demonstrated intermediate skills in developing investigative strategies or 2-5 years of experience Specialized knowledge/training in healthcare FWA investigations NHCAA, AHFI, CFE credentials All Telecommuters must adhere to UnitedHealth Group\'s Telecommuter Policy Additional Information
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. Salary range for this role is $58,800 to $105,000 annually based on full-time employment. In addition to salary, a comprehensive benefits package is offered, with eligibility requirements applying. UnitedHealth Group is an Equal Employment Opportunity employer. UnitedHealth Group is a drug-free workplace, and candidates may be required to pass a drug test before employment.
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Senior Investigator-Telecommute Kentucky role at
UnitedHealthcare . 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 conducts investigations which may include field work to perform interviews and obtain records and/or other relevant documentation. Schedule: Monday-Friday Standard Business Hours. You’ll enjoy the flexibility to telecommute from anywhere within the state of
Kentucky
as you take on some tough challenges. Responsibilities
Assess complaints of alleged misconduct received within the company 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 latter Communicate effectively in written and verbal forms 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 with 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 to include attendance at workgroups or regulatory meetings Benefits and Requirements
Required Qualifications
Bachelor's degree OR associate's degree with 3+ years of equivalent work experience in healthcare-related employment 3+ years of experience in healthcare fraud, waste and abuse (FWA) 2+ years of experience in state or federal regulatory FWA requirements 2+ years of experience in analyzing data to identify fraud, waste and abuse trends Intermediate level of proficiency in Microsoft Excel and Word Ability to travel locally (in-state) up to 25% of the time, as needed Ability to participate in legal proceedings, arbitration and depositions at the direction of management Access to reliable transportation and valid US driver’s license Reside in the state of Kentucky Preferred Qualifications
Demonstrated intermediate knowledge of health care policies, procedures and documentation standards or 2-5 years of experience Demonstrated intermediate skills in developing investigative strategies or 2-5 years of experience Specialized knowledge/training in healthcare FWA investigations NHCAA, AHFI, CFE credentials All Telecommuters must adhere to UnitedHealth Group\'s Telecommuter Policy Additional Information
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. Salary range for this role is $58,800 to $105,000 annually based on full-time employment. In addition to salary, a comprehensive benefits package is offered, with eligibility requirements applying. UnitedHealth Group is an Equal Employment Opportunity employer. UnitedHealth Group is a drug-free workplace, and candidates may be required to pass a drug test before employment.
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