Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work.(sm) The Investigations Consultant will be responsible for triaging, investigating and resolving instances of healthcare fraud and / or abusive conduct by the medical profession, insured members or the broker community. This individual will be utilizing information from claims data analysis, plan members, employees conduct confidential investigations and document relevant findings. They will report any illegal activities in accordance with all laws and regulations. The Consultant may also conduct onsite provider claim and / or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation. They will act as a subject matter with identifying, communicating and recovering losses as deemed appropriate. Where applicable, they will provide testimonials regarding the investigation. Primary Responsibilities:Identify gaps and inefficiencies in existing policies and procedures and suggest effective and efficient solutions Investigative Consultant will verify the validity of all addresses associated to a High-Risk Laboratory including, but not limited to, Google Maps searches and / or on-site visits Investigative Consultant will perform background checks on all employees / entities, as well as further analytics to identify past/present association(s) with laboratory terminated from the Network and / or engagement in FWA activity Investigative Consultant will validate one (1) years' worth of invoices and / or other applicable documentation, as well as correlating billing records Investigative Consultant will verify current laboratory equipment, including purchase orders and serial numbers Investigative Consultant will execute unannounced Laboratory inspections, to ensure compliance with state and / or federal regulations, codes and statutes Obtain and analyze claims billing and payment data as necessary in the course of conducting complex investigations of allegations of criminal or civil fraud Testify in criminal, civil and / or administrative proceedings as required Interview witnesses who have knowledge of alleged fraud/abuse activity Prepare comprehensive case investigation reports including evidence and findings
Required Qualifications:Bachelor Degree in Business or Criminal Justice or related field. (Significant investigations work experience in lieu of Bachelor Degree will be considered.) Five (+) years of experience working in a Compliance organization, fraud investigation unit, law enforcement agency or Laboratory Previous experience with government healthcare programs (Medicare, Medicaid and / or TriCare) An intermediate level of proficiency in MS Excel, MS Word and MS Access An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to insurance Preferred Qualifications:Medical Lab Scientist (MLS), Clinical Lab Scientist (CLS), Medical Lab Technician (MLT) Industry Certifications, i.e. AHFI, CFE, etc.Previous experience / employment with a LaboratoryLaboratory claims processing knowledge Knowledgeable on Federal / State Requirements and Administrative Rules for LaboratoriesCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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) 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: Investigations Consultant, Compliacne, Fraud, MLS, CLS, MLT, AHFI, CFE, San Antonio, Dallas, Houston, Austin, TX, Texas,
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.