Fraud Analyst - Remote

UnitedHealth Group•Nashville, TN

1d•Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Requirements

2+ years of experience in a transactional review / processing environment
Equivalent experience in enrollment
Experience using bank and/or identity validation tools
Demonstrated experience: Conducting outbound calls, Asking probing questions to gather facts, Assessing risk and documenting findings
Proven solid communication skills with attention to detail (written and verbal)
Proven ability to work independently in a remote environment with high integrity
Intermediate proficiency in Microsoft 365 (Excel, Word, PowerPoint, SharePoint)

Nice To Haves

Proven comfortable in a fast-paced, evolving environment
Proven ability to adapt and pivot as business needs change
Proven growth mindset with a proactive, “can-do” approach

Responsibilities

Gather and analyze pertinent data to identify and solve a range of problems within area of expertise
Conduct moderately complex analyses and translate concepts into practical application
Investigate non-standard requests and problems with some guidance as needed
Conduct outbound calls with providers, customers, clients, and payers to gather information
Communicate effectively with internal business partners and external stakeholders (verbal and written)
Provide explanations and guidance on processes within area of expertise
Manage and prioritize assigned caseloads to meet mandated turnaround times
Accurately document and track all cases for processing or investigation
Provide ongoing reporting and analysis of risk reviews to stakeholders
Analyze and aggregate information from interviews and multiple data sources
Identify risk indicators by connecting patterns across various factors
Apply internal and external best practices to risk evaluation
Ask probing questions to uncover drivers and contributing risk factors
Conduct risk-based transactional reviews using available tools and systems
Gather relevant information such as: Enrollment data, Validation checks, Internet research, Payment records, Provider interviews
Ensure findings are properly documented and resolved
Perform preliminary investigations on identified discrepancies
Apply knowledge of enrollment processes and validation standards
Utilize systems to monitor status and drive case progression
Prepare documentation for internal teams, legal/regulatory groups, and external agencies
Track and report financial impact (losses, recoveries, savings)
Demonstrate understanding of: Provider enrollment processes, Payment processing workflows, Applicable platforms (e.g., enrollment systems, SF.com, validation tools)
Use desktop tools to analyze and validate data
Adhere to SOPs, process libraries, and internal tracking guidelines
Ensure compliance with applicable regulations including: HIPAA, CMS, PPACA, State-specific requirements
Follow contractual obligations (provider, payer, and client agreements)
Complete all required compliance and legal training