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)
There’s no sugar coating it - fraud is rampant in health care. And with a projected total spend at nearly $3 trillion, the stakes couldn’t be higher. But it’s not just the financial losses that we’re worried about. We’re in the business of making the health care system work better for everyone, so the abuse impacts millions of lives too. As a Lead Investigator, you’ll review claims, look for patterns of potential fraud, waste and/or abuse and interact with medical providers to complete investigations. You’ll be fully invested in the outcomes and will be helping the health system work better for everyone with the support and resources of a Fortune 5 industry leader.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Establish, mandate, and implement standard policies, procedures and best practices regarding UnitedHealthcare Investigations’ claim sampling and extrapolation methodologies and other tasks as delineated by UnitedHealthcare Investigations’ Leadership
- Support and perform the collection of data for investigation needs, identify investigative data universe, perform statistically valid random sampling, coordinate and develop reports, projects, using well established knowledge of health care related data manipulation tools
- Predict and detect emerging health care fraud trends and develop innovative technological solutions to identify them
- Conduct state and federal legal research and monitor changes in requirements to mitigate risks and achieve compliance
- Develop compliance communications and drive problem resolution for a business segment across UnitedHealth Group
- Assist other team members in researching and investigating potential fraud, waste and/or abuse cases
- Travel for meetings, training, investigational activities, etc.
Analyzing the sheer magnitude of investigative findings will be the toughest part of your role. You will serve as a subject matter expert in uncovering common themes, recovery, and testimonials. You will do limited field work, primarily reporting on patterns trending in investigations.
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.
- Bachelor's Degree in Mathematics, Statistics and/or areas of related study
- 5+ years of experience working in a government, legal, health care, managed care and/or health insurance environment in a regulatory, privacy, compliance, or investigation’s role
- Experience communicating complex information via phone conversations and emails to non-technical clients, external customers, internal customers, and executives
- Experience interacting & collaborating with a variety of stakeholders (other team members, internal customers, and executives)
- Intermediate or better proficiency with MS Word, MS Outlook, MS Access, SQL, SAS
- Advanced proficiency with MS Excel, VBA, Statistical Sampling Tools (RAT STATS)
- Ability to travel 25% for business purposes
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
- Experience working with Medicare, Medicare Advantage, Medicare Part D, Medicaid and/or Tricare regulations
- Familiarity with “big” data manipulation tools such as SAS, Toad, Python, Tableau, Alteryx, etc.
- Familiarity with statistical tools in healthcare
- Familiarity with software engineering
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 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.
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $64,800 to $116,000. The salary range for Connecticut/Nevada residents is $71,400 to $127,400. 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, you’ll find a far-reaching choice of benefits and incentives.
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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