Pharmacy Investigator - 2170482

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Job Code
2170482
Jobs Rated
41st
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 PharmacyInvestigator
reports directly to the Manager of Investigations. ThePharmacyInvestigatoris responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. ThePharmacyInvestigatorwill utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. ThePharmacyInvestigatoris responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.
If you reside in New Jersey, New York or Pennsylvania, youll enjoy the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities
Investigate medium to highly 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 Units (SIUs) 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 later
Communicate effectively, to include written and verbal forms of communication
Develop goals and objectives, track progress and adapt to changing priorities
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 work-groups or regulatory meetings
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 Associate's Degree (or higher) with 2 years of work experience within healthcare field
2 years of experience in health care fraud, waste and abuse (FWA)
2 years of experience in state or federal regulatory FWA requirements
2 years of experience analyzing data to identify fraud, waste and abuse trends
Intermediate level of proficiency with Microsoft Excel and Word
Reside in the states of New Jersey, New York or Pennsylvania with the ability to travel up to 50% in the tri-state area (i.e., NJ, NY, PA)
Ability toparticipate in legal proceedings, arbitration, and depositions at the direction of management
Preferred Qualifications:
2 years of experience in health care policies, procedures, and documentation standards
2 years of experience developing investigative strategies
Specialized knowledge/training in healthcare FWA investigations
Active affiliations:
National Health Care Anti-Fraud Association (NHCAA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)
Licensed and/or Certified Pharmacy Technician (CPhT)
Intermediate knowledge in pharmacy claims processing
Operational experience with a pharmacy and/or pharmacy benefits manager (PBM)
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.
New York and New Jersey
Residents Only
The salary range for
California, Colorado, Nevada,
Connecticut,
New York, New Jersey,
Rhode Island or
Washington
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 - free workplace. Candidates are required to pass a drug test before beginning employment.
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Categories
Healthcare
Government
Jobs Rated Reports for Pharmacist
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Jobs Rated Report 2017
Posted:
2023-06-01
Expires:
2023-07-01
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