Sr. Investigator – National Remote

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. 

 

Here’s a statistic that will stop you cold: Our country spends nearly $3 trillion on health care annually. With that kind of money at play, you can be sure some individuals will figure out a way to get a piece of it illegally. Now, that doesn’t even take into account the millions of lives that are held in the balance as well. This is fraud on a scale you couldn’t begin to imagine. As a Senior Investigator, you will play a part in putting a stop to it. It’s critical work that that you will want to be a part of. Apply today.

Schedule: is Monday-Friday standard business hours. No nights, no weekends and no holidays!

Travel 0-10%.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities: 

• Conduct confidential investigations, document relevant findings and report any illegal activities in accordance with all laws and regulations
• Review claims, look for patterns of potential fraud, waste and/or abuse and interact with medical providers to request medical records for investigations
• Conduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation

The challenge for you will be the high volume of cases on your plate at one time. You will be part of a team responsible for triaging, investigating and resolving instances of healthcare fraud and/or abusive conduct. You will spend your time doing audits, claims data analysis, conducting investigations and putting together your findings. 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma required or undergraduate degree in the area of criminal justice or related field 
• 2+ years of experience working in a government, legal, law enforcement, investigations, healthcare, managed care and/or health insurance environment
• 2+ years of experience in a position processing medical claims and/or investigating fraud (healthcare fraud investigations experience)
• 2+ years of experience communicating complex information via phone conversations and emails to non-technical clients, providers, internal customers, outside law enforcement agencies and executives; must have solid ability to accurately document findings in written form

Preferred Qualifications:

• Bachelor’s Degree
• 3+ years of experience working in the group health business preferred, particularly within claims processing
• 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, iDRS, CSP, Macess or other claims processing systems.
• Certified Coding Specialist 
• Certified Fraud Examiner 

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

 

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington or Washington, D.C. Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington or Washington, D.C. residents is $58,300 to $114,300 per year. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. 

 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

 

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.

 

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

 

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