Sr. Investigator, Office Based - Telecommute in LA

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Posted 3 days ago United States Salary undisclosed
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Job Description

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

The Senior Investigator will be responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. This individual will also data mine, conduct research and analyze providers by utilizing claims data, medical coding guidelines and their keen eye to identify abhorrent medical billing practices and patterns. In addition, the individual will be responsible to conduct investigations which may include field work to perform interviews and obtain medical records/ and other relevant documentation. The Senior Investigator will also act as subject matter expert in researching and communicating their findings both orally and in writing and will be responsible to report any illegal activities in accordance with all applicable laws.

If you are located within the state of LA, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

The SIU Senior Investigator reports directly to the SIU Manager. The primary responsibility of the Senior Investigator is to investigate medium to highly complex cases of fraud, waste and abuse.Under the direction of the SIU Manager, the Senior Investigator's principle responsibilities include:

  • Detecting fraudulent activity by members, providers, employees and other parties against the Company and deciding the most effective and efficient method of investigation
  • Maintaining accurate, current and thorough case information in the SIU Case Tracking Database
  • Securing documentation, either internally or externally, and preparing summaries of the findings from the documentation
  • Documenting the evidence and drawing conclusions based on the investigative findings and preparing summaries of the investigative findings and case outcome
  • Representing the Company in conducting settlement negotiations
  • Gathering objective evidence in support of investigation outcomes
  • Collecting, collating, analyzing and interpreting data, both internally and externally, relating to fraud, waste and abuse referrals
  • Controlling and maintaining Company and departmental data to ensure confidentiality in accordance with the Data Release Governance Program
  • Reporting suspected fraud, waste and abuse to appropriate federal or state government regulators
  • Attending at least 9 hours of continuing anti-fraud training annually

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 in Criminal Justice or related field or Associates degree and 2+ years experience with healthcare related employment
  • Intermediate level of proficiency in MS Excel and MS Word
  • Intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to healthcare fraud
  • Experience analyzing and interpreting data to identify trends, patterns, and generate leads for the team
  • Must live within the state of Louisiana
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Requirements:

  • Experience within a healthcare Special Investigations Unit
  • Knowledge of medical terminology
  • Knowledge of medical coding (CPT, HCPCS, ICD-9, ICD-10)
  • Detail oriented with excellent organizational and analytical skills
  • Ability to communicate effectively both verbally and in writing
  • Strong listening and writing skills
  • Independent, reliable and responsible
  • CPC, AHFI or CFE
  • Live within a commutable distance of Metairie, LA

UnitedHealth Group serves the health benefits needs for millions. The impact is huge and the work is historical. Join us and help us protect the integrity of the health care system while doing your life's best work.(sm)

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 7 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

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

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.

Job Keywords: Sr Investigator, Office Based, Data, Excel, Access, Analyst, Data Investigator, Metairie, LA, Louisiana