Investigations Consultant - Telecommute within Louisiana
January 12, 2018
Eden Prairie, Louisiana
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 6 industry leader. Primary Responsibilities Conduct confidential investigations, document relevant findings and report any illegal activities in accordance with all laws and regulationsConduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigationServe as a team lead, assisting other team members in researching and investigating potential fraud, waste and/or abuse casesAnalyzing 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 testimonialsYou will do limited field work, primarily reporting on patterns trending in investigationsIf you are located in Louisiana, you will have the flexibility to telecommute* as you take on some tough challenges.
Required Qualifications:Undergraduate degree or equivalent work experience3+ years of healthcare investigations experienceAn intermediate level of proficiency in MS Excel and WordAn intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to insurance requiredAbility to travel up to 25% within the state of LouisianaMust live within the state of LouisianaPreferred Qualifications:Investigative experience within pharmacy or laboratoryExcellent verbal and written communication skillsUndergraduate degree in the area of Criminal Justice or related fieldMS Access experience Certifications: Accredited Healthcare Fraud Investigator (AHFI) , Certified Fraud Examiner (CFE) , Certified Professional Coder (CPC)Experience with Medical/Pharmacy, Fraud Waste and Abuse (FWA)Experience with a Pharmacy Benefit Manager (PBM) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy Every day, we work to make communities healthier. It's the promise that is at the core of who we are. And our employees' expertise makes all the difference in achieving our goal. Join our elite team today and start doing 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, Accredited Healthcare Fraud Investigator (AHFI) , Certified Fraud Examiner (CFE) , Certified Professional Coder (CPC), Medical/Pharmacy, Fraud Waste and Abuse (FWA), Pharmacy Benefit Manager (PBM), Local, State & Federal laws and regulations, law enforcement investigation, insurance claims, Investigate, Prevent and Enforce Violations, Health Care Fraud Investigator, specializing in Medical/Provider Fraud, Louisiana, LA
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.