Bring us yourexperience, your head for strategy, your strength with relationships and youreye for opportunity. In return we offer an unmatched place to grow and developyour career among a richly diverse group of businesses driven by the power andstability of a leading health care organization. Come help us heal andstrengthen the health care system as you do your life's best work.(sm) The InvestigationsConsultant will be responsible for triaging, investigating and resolvinginstances of healthcare fraud and abusive conduct by medical professionals,insured members or the broker community. This individual will be leveraginginformation from claims data analysis, plan members, employee's conduct,confidential investigations and document relevant findings. The Consultant mayconduct onsite provider claim and clinical audits to gather and analyze allnecessary information and documents related to the investigation. They will actas a subject matter with identifying, communicating and recovering losses asdeemed appropriate. Where applicable, they will provide testimonials regardingthe investigation.
Requirements:- Undergraduate degreeor equivalent work experience - 3+ years healthcareinvestigations experience - An intermediatelevel of proficiency in MS Excel and Word- An intermediatelevel of knowledge with Local, State & Federal laws and regulationspertaining to insurance required. - Ability to travel upto 25% within the state of Mississippi Preferred Requirements:- Excellent verbal andwritten communication skills. - Undergraduate degreein the area of Criminal Justice or related field- MS Access experience- Certifications:Accredited Healthcare Fraud Investigator (AHFI) , Certified Fraud Examiner (CFE) , Certified Professional Coder (CPC)- Experience withMedical/Pharmacy, Fraud Waste and Abuse (FWA)- Experience with aPharmacy Benefit Manager (PBM) Careers with UnitedHealthcare. Let's talk aboutopportunity. Start with a Fortune 6 organization that's serving more than 85million people already and building the industry's singular reputation for boldideas 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. Webring them the resources of an industry leader and a commitment to improvetheir lives that's second to none. This is no small opportunity. It's where youcan do your life's best work.SM Diversity creates ahealthier atmosphere: UnitedHealth Group is an Equal EmploymentOpportunity/Affirmative Action employer and all qualified applicants willreceive consideration for employment without regard to race, color, religion,sex, age, national origin, protected veteran status, disability status, sexualorientation, gender identity or expression, marital status, geneticinformation, or any other characteristic protected by law. UnitedHealth Group isa drug-free workplace. Candidates are required to pass a drug test beforebeginning employment. Keywords:Investigations, Accredited Healthcare Fraud Investigator (AHFI) , CertifiedFraud Examiner (CFE) , Certified Professional Coder (CPC),Medical/Pharmacy, Fraud Waste and Abuse (FWA), Pharmacy Benefit Manager (PBM),Local, State & Federal laws and regulations, Jackson, MS, Mississippi, lawenforcement investigation, insuranceclaims, Investigate, Prevent and Enforce Violations, Health Care FraudInvestigator, specializing in Medical/Provider Fraud
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.