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. Some things are just inevitable. You know that wherever there's a large sum of money at stake, there will be people ready to snatch more than their fair share. So it is with health care. At nearly $3 trillion dollars spent on health care annually in the United States, the potential for fraud reaches as high as 10 percent, or $230 billion annually. And that's not even counting the millions of lives that are affected. As an Investigator, you can help put an end to it. You'll be helping safeguard the health of millions of people and making the health system work better for everyone. You’ll 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, 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 • Provide testimonials regarding the investigation The trick for you is in searching through loads of data to identify and resolve instances of health care fraud and/or abuse. The volume of information is high and you'll be tested in utilizing information from claims data analysis and from tips and complaints from plan members, the medical community and law enforcement agencies. You'll be part of a team responsible for triaging, investigating and resolving these cases. 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 with 2 years of equivalent work experience with healthcare related employment • Demonstrated basic level of knowledge in health care fraud, waste and abuse (FWA) or minimum of 2 years of experience or less • Demonstrated basic level of knowledge in state or federal regulatory FWA requirements or minimum of 2 years of experience or less • Demonstrated basic level of knowledge analyzing data to identify fraud, waste and abuse trends or minimum of 2 years of experience or less • Must participate in legal proceedings, arbitration, and depositions at the direction of management • Demonstrated basic level of proficiency in Microsoft Excel and Word or minimum of 2 years of experience or less • Ability to travel up to 25% within respective geographical area Preferred Qualifications: • 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) • Certified Professional Coder (CPC) • Medical Laboratory Technician (MLT) • All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. California, Colorado, Nevada,Connecticut,New York, New Jersey,Rhode Island, Hawaii orWashington Residents Only:The salary range forCalifornia, Colorado, Nevada,Connecticut,New York, New Jersey,Rhode Island, orWashingtonresidents is $48,300 to $94,500per 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 Groupis a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN Apply Job!