Job Description
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 is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The
Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The
Investigator is responsible to conduct investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.
If you reside within the state of New Jersey, New York, and Pennsylvania, you will enjoy the flexibility to telecommute* as you take on some tough challenges.
Travel: Up to 50%
Primary Responsibilities - Assess complaints of alleged misconduct received within the Company
- Investigate low to medium 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 Unit’s (SIU’s) 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
- 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 workgroups or regulatory meetings
- Communicate effectively, to include written and verbal forms of communication
- Develop goals and objectives, track progress and adapt to changing priorities
What Are The Reasons To Consider Working For UnitedHealth Group? Put It All Together - Competitive Base Pay, a Full And Comprehensive Benefit Program, Performance Rewards, And a Management Team Who Demonstrates Their Commitment To Your Success. Some Of Our Offerings Include
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- More information can be downloaded at:
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 - Bachelor’s degree OR Associates degree AND 2+ years of related healthcare experience
- Beginner level of proficiency in Microsoft Excel and Word
- Ability to travel up to 50% of the time within PA, NY, and NJ
- Reside in PA, NY, or NJ - commutable distance to Philadelphia, Kings, Essex counties
- Must participate in legal proceedings, arbitration, and depositions at the direction of management
Preferred Qualifications - Basic level of knowledge in health care policies, procedures, and documentation standards
- Basic level of skills in developing investigative strategies
- Basic level of knowledge in analyzing data to identify FWA trends
- Basic level of knowledge in state and federal regulatory FWA requirements
- Specialized knowledge/training in healthcare fraud, waste, and abuse (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)
- Basic knowledge in pharmacy claims processing
- Operational experience with a pharmacy and/or pharmacy benefits manager (PBM)
- All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
The salary range for this role is $49,300 to $96,400 annually based on full-time employment. 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.
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. #RPO #YELLOW
Job Tags
Minimum wage, Holiday work, Full time, Temporary work, Work experience placement, Local area, Remote job,