Senior Medical Investigator - Fraud, Waste & Abuse
Company: UnitedHealth Group
Location: Austin
Posted on: May 28, 2023
Job Description:
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 doingyour life's best
work.SM The Senior Medical Investigator reports directly to the
Manager of Investigations. The Senior Medical Investigator is
responsible for identification, investigation and prevention of
healthcare fraud, waste and abuse. The Senior Medical Investigator
will utilize claims data, applicable guidelines and other sources
of information to identify aberrant billing practices and patterns.
The Senior Medical Investigator is responsible to conduct
investigations which may include field work to perform interviews
and obtain records and/or other relevant documentation.If you
reside in Texas, you'll enjoy the flexibility to telecommute* as
you take on some tough challenges.Primary Responsibilities:
- Investigate medium to highly complex cases of fraud, waste and
abuse.
- Detect fraudulent activity by members, providers, employees and
other parties against the Company
- Develop and deploy the most effective and efficient
investigative strategy for each investigation
- Maintain accurate, current and thorough case information in the
Special Investigations Unit's (SIU's) case tracking system
- Collect and secure documentation or evidence and prepare
summaries of the findings.
- Participate in settlement negotiations and/or produce
investigative materials in support of the later
- Communicate effectively, to include written and verbal forms of
communication
- Develop goals and objectives, track progress and adapt to
changing priorities
- Collect, collate, analyze and interpret data relating to fraud,
waste and abuse referrals.
- Ensure compliance of applicable federal/state regulations or
contractual obligations
- Report suspected fraud, waste and abuse to appropriate federal
or state government regulators
- Comply with goals, policies, procedures and strategic plans as
delegated by SIU leadership
- Collaborate with state/federal partners, at the discretion of
SIU leadership, to include attendance at work-groups or regulatory
meetingsYou'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:
- Bachelor's Degree (or higher) or Associates Degree (or higher)
with 3+ years of Medicaid or CHIP Fraud, Waste, and Abuse
investigatory experience OR Certification such as Association of
Certified Fraud Examiners, National Health Care Anti-Fraud
Association, etc.
- 3+ years of experience demonstrating intermediate level of
knowledge in health care fraud, waste and abuse (FWA)
- 3+ years of experience demonstrating intermediate level of
knowledge in state or federal regulatory FWA requirements
- 3+ years of experience demonstrating intermediate level of
knowledge analyzing data to identify fraud, waste and abuse
trends
- Intermediate level of proficiency in Microsoft Excel and
Word
- Ability to travel up to 25%
- Reside in the state of Texas
- Ability to participate in legal proceedings, arbitration, and
depositions at the direction of managementCareers with
UnitedHealthcare. Work with a Fortune 5 organization that's serving
millions of people as we transform health care with bold ideas.
Bring your energy for driving change for the better. Help us
improve health access and outcomes for everyone, as we work to
advance health equity, connecting people with the care they need to
feel their best. As an industry leader, our commitment to improving
lives is second to none. *All Telecommuters will be required to
adhere to UnitedHealth Group's Telecommuter Policy. 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. #RPO,
#Yellow
Keywords: UnitedHealth Group, Austin , Senior Medical Investigator - Fraud, Waste & Abuse, Healthcare , Austin, Texas
Didn't find what you're looking for? Search again!
Loading more jobs...