Senior 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 Senior Investigator will be responsible for investigating agent/broker complaints across all lines of business in accordance with state and federal regulations. You will enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.
Requirements
- High School Diploma/GED (or higher)
- Advanced level of proficiency with communicating complex information both verbally and in written form
- Intermediate level of knowledge of Local, State & Federal laws and regulations pertaining to Affordable Care Act Plans
- Intermediate level of proficiency in MS Office Suite Products (Excel and Word)
Nice To Haves
- Fraud Certification, such as CFE of AHFI
- 3+ years of Investigative experience
- 2+ years of healthcare related experience
- Experience directly in Healthcare/Insurance related Compliance, Investigations or Operations
- Experience using internal systems including Facets, Doc360, Maestro, Alvar
- Intermediate level knowledge of Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, and/or commercial health insurance)
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 on 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 products
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
Senior
Education Level
High school or GED
