UnitedHealth Group
Senior Investigator - Remote in Ohio
UnitedHealth Group, Columbus, Ohio, United States, 43224
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
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. Responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.
If you reside in the state of
Ohio , you will have the flexibility to telecommute as you take on some tough challenges.
Schedule: Monday-Friday 8:00am - 4:30pm EST
Primary 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, including 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 workgroups or regulatory meetings
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
More information can be downloaded at: http://uhg.hr/uhgbenefits
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Bachelor's Degree or Associate's Degree with 2+ years of equivalent work experience and healthcare related employment
2+ years of experience in health care fraud, waste and abuse (FWA)
2+ years of experience in state or federal regulatory FWA requirements2+ 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 & valid US driver's license
Preferred Qualifications:
Specialized knowledge/training in healthcare FWA investigations
National Health Care Anti-Fraud Association (NHCAA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)
Certified Professional Coder (CPC)
Demonstrated an intermediate level of knowledge in health care policies, procedures, and documentation standards or 2-5 years of experience
Demonstrated intermediate level of skills in developing investigative strategies or 2-5 years of experience
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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Caring. Connecting. Growing together.
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. Responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.
If you reside in the state of
Ohio , you will have the flexibility to telecommute as you take on some tough challenges.
Schedule: Monday-Friday 8:00am - 4:30pm EST
Primary 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, including 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 workgroups or regulatory meetings
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
More information can be downloaded at: http://uhg.hr/uhgbenefits
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Bachelor's Degree or Associate's Degree with 2+ years of equivalent work experience and healthcare related employment
2+ years of experience in health care fraud, waste and abuse (FWA)
2+ years of experience in state or federal regulatory FWA requirements2+ 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 & valid US driver's license
Preferred Qualifications:
Specialized knowledge/training in healthcare FWA investigations
National Health Care Anti-Fraud Association (NHCAA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)
Certified Professional Coder (CPC)
Demonstrated an intermediate level of knowledge in health care policies, procedures, and documentation standards or 2-5 years of experience
Demonstrated intermediate level of skills in developing investigative strategies or 2-5 years of experience
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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