Investigator National Remote

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.

Some things are just inevitable. You know that wherever theres a large sum of money at stake, there will be people ready to snatch more than their fair share. So it is with health care. At nearly $3 trillion dollars spent on health care annually in the United States, the potential for fraud reaches as high as 10 percent, or $230 billion annually. And thats not even counting the millions of lives that are affected. As an Investigator, you can help put an end to it. Youll be helping safeguard the health of millions of people and making the health system work better for everyone.

The trick for you is in searching through loads of data to identify and resolve instances of health care fraud and/or abuse. The volume of information is high and youll be tested in utilizing information from claims data analysis and from tips and complaints from plan members, the medical community and law enforcement agencies. Youll be part of a team responsible for triaging, investigating and resolving these cases.

Travel 0-10%.

Schedule: Monday-Friday, standard business hours. No nights, no weekends and no holidays!

You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Conduct confidential compliance investigations related to Agents/Brokers across all lines of business

Document all relevant findings in written reports

Utilize information from plan members (interviews), agents/brokers, sales operations, claims data, and internal systems

Conduct and document interviews (on telephone and in person) for all parties involved in an investigation

Report any illegal activities in accordance with all laws and regulations

Act as a subject matter expert with identifying and communicating relevant findings to the business

Where applicable, provide testimony regarding the investigation

Responsible for generating independent work product

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:

High School Diploma/GED (or higher)

2 years of experience working in a government, legal, law enforcement, investigations, health care, managed care and/or health insurance sales environment

2 years of experience in a position investigating fraud (health care fraud investigations experience preferred)

2 years experience working independently and researching/conducting investigations; must be self-motivated, goal oriented and have the ability to work independently to successfully investigate complex issues

Preferred Qualifications:

Bachelors degree in the area of criminal justice or related field

2 years of experience working in the group health business preferred, health insurance sales or sales compliance

An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, and/or commercial health insurance)

Experience with Facets, or other claims processing systems

Certified Fraud Examiner preferred

All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C Residents Only : The salary range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C residents is $48,300 to $94,500 per year. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

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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