Investigator-Remote-Ohio

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 in the state of Ohio , you'll enjoy the flexibility to telecommute

• as you take on some tough challenges.

Primary Responsibilities :

Assess complaints of alleged misconduct received within the Company

Investigate low to medium complex cases of fraud, waste and abuse

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

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 :

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 associate degree plus two years of equivalent work experience with healthcare related employment

Basic level of knowledge OR 2 years of experience in state or federal regulatory FWA requirements

Basic level of knowledge OR 2 years of experience analyzing data to identify fraud, waste and abuse trends

Basic level of proficiency OR 2 years of experience in Microsoft Excel and Word

Ability to participate in legal proceedings, arbitration, and depositions at the direction of management

Currently reside within the state of Ohio OR the ability to relocate at your own expense

Ability to travel up to 25% of the time

Preferred Qualifications :

Active Affiliations :

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $48,700 to $87,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #GREEN