Investigator Compliance Investigations Unit - 2165600

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Job Code
2165600
At UnitedHealthcare, were 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 and start doing your lifes best work.
SM
The Sr. Investigator
will be responsible for investigating agent/broker complaints across all lines of business in accordance with state and federal regulations.
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.
Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary 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
Youll 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:
Bachelors Degree (or higher) OR High School Diploma/GED and 2 years of loss prevention, risk management, legal compliance, or asset protection experience
Preferred Qualifications:
Fraud Certification, such as CFE of AHFI
2 years of investigative experience
Experience directly in Healthcare/Insurance related Compliance, Investigations or Operations
Experience with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, Affordable Care Act Plans, and/or commercial health insurance)
Experience communicating complex information both verbally and in written form
Basic level of knowledge in analyzing data to identify fraud, waste and abuse trends
Basic level of proficiency in MS Excel and MS Word
Familiarity with MS Access
Soft Skills:
Excellent verbal and written communication skills
Careers with UnitedHealthcare.
Work with a Fortune 5 organization thats serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.
*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.
California, Colorado, Connecticut, Nevada, New York, Washington or Rhode Island Residents Only:
The salary range for California, Colorado, Connecticut, Nevada, Washington or New York City residents is $56,300 to $110,400.Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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, youll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves 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 - ****
Expires:
2023-07-01
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