Investigator
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 will be responsible for investigating agent/broker complaints across all lines of business in accordance with state and federal regulations. Travel 0-10%25. Schedule: Monday-Friday, standard business hours. No nights, no weekends and no holidays! You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.
Requirements
- High School Diploma/GED
- 2+ years of experience working independently and researching/conducting investigations
- 1+ years of experience in a position investigating fraud (health care fraud investigations experience preferred)
Nice To Haves
- Bachelor’s degree in criminal justice or related field
- 2+ years of experience working in the group health business preferred, health insurance sales or sales compliance
- An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, and/or commercial health insurance)
- Experience with Facets, or other claims processing systems
- Certified Fraud Examiner preferred
Responsibilities
- Conduct confidential compliance investigations related to Agents/Brokers across all lines of business
- Document all relevant findings in written reports
- Utilize information from plan members (interviews), agents/brokers, sales operations, claims data, and internal systems
- Conduct and document interviews (on telephone and in person) for all parties involved in an investigation
- Report any illegal activities in accordance with all laws and regulations
- Act as a subject matter expert with identifying and communicating relevant findings to the business
- Where applicable, provide testimony regarding the investigation
- Responsible for generating independent work product
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
