Special Investigation Unit - Investigator - National Remote | UnitedHealthcare

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

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 and start doing your life’s best work.SM

Special Investigation Unit - State Investigators are tasked with the responsibility of detecting, investigating, and determining future action on potential fraudulent billing activity. We are seeking a candidate who is curious, innovative, and passionate about serving our customers by reducing the total cost of health care. Strong communication skills and the ability to thrive in a changing environment are essential. As part of our Payment Integrity team, you’ll help understand, evaluate, and prevent payments made in situations with fraud, waste, abuse, and errors. You’ll have all the tools and backing you need to help analyze claims and ensure adherence to procedures and compliance policies. All the while, you’ll be building your career with a leader and reaching for the highest levels of performance as you do your life’s best work.SM

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours during training will be 8am to 5pm, Monday - Friday.

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

Primary Responsibilities:

• Detect, analyze and investigate complex types of fraud, waste, abuse and error activity
• Evaluate referrals and information from multiple data sources to determine if fraud, waste and abuse is suspected and what investigation is required
• Organize assigned service specific edit reviews, securing needed information, completing prepayment claim reviews and document findings.
• Conduct highly complex and confidential investigations, including coordination with other investigators for cases during initial and ongoing investigation, escalations and closure
• Communicate case updates to internal stakeholders, escalating when appropriate
• Work independently

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 equivalent experience
• 1+ years of experience analyzing and solving customer problems
• Ability to create, edit, copy, send and save documents, correspondence and spreadsheets in Microsoft Excel, Microsoft Word, and Microsoft Outlook
• Must be 18 years of age or older.
• Ability to work during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 3+ years of current or previous UMR CPS/ Jacada experience (UMR is UnitedHealthcares third-party administrator (TPA) solution). You must be a previous or current employee of UMR/UHSS specifically to have the required experience with the UMR CPS system.
• Experience working in the healthcare industry.
• Knowledge of medical claims billing (ICD - 10, CPT and / or HCPC codes).
• Familiarity with resources such as EncoderPro, Knowledge Library, and / or UMR Policies and Procedures.

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

California, Colorado, Connecticut, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Nevada / New York / New Jersey / Washington / Rhode Island residents is $18.80 - $36.78 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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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