Investigator

UnitedHealth Group • Monroe, LA

153d • $48,700 - $87,000 • Remote

About The Position

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.

Requirements

• Bachelor's degree or Associate's degree with 2+ years of equivalent work experience with healthcare related employment
• Ability to participate in legal proceedings, arbitration, and depositions at the direction of management
• Ability to travel up to 25% of the time
• Reside in the state of Louisiana
• Access to reliable transportation & valid US driver's license

Nice To Haves

• Basic level of knowledge of health care fraud, waste, and abuse (FWA)
• Basic level of knowledge of state or federal regulatory FWA requirements
• Basic level of knowledge of analyzing data to identify fraud, waste and abuse trends
• Basic level of proficiency with Microsoft Excel and Word
• Valid US driver's license
• Active Affiliations: National Health Care Anti-Fraud Association (NHCAA), Accredited Health Care Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Medical Laboratory Technician (MLT)

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 latter
• 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, including written and verbal forms of communication
• Develop goals and objectives, track progress and adapt to changing priorities

Benefits

• 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.)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree