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Sr. Investigator - Baton Rouge, Metairie preferred (Office based) or Telecommute within Louisiana

  • UnitedHealth Group
  • Metairie, LA, USA
  • Jul 20, 2020
Law Enforcement

Job Description

Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work.(sm)

The Senior Investigator will be responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. This individual will also data mine, conduct research and analyze providers by utilizing claims data, medical coding guidelines and their keen eye to identify abhorrent medical billing practices and patterns. In addition, the individual will be responsible to conduct investigations which may include field work to perform interviews and obtain medical records/ and other relevant documentation. The Senior Investigator will also act as subject matter expert in researching and communicating their findings both orally and in writing and will be responsible to report any illegal activities in accordance with all applicable laws.

The SIU Senior Investigator reports directly to the SIU Manager. The primary responsibility of the Senior Investigator is to investigate medium to highly complex cases of fraud, waste and abuse.

If you are located in Louisiana, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

* Detecting fraudulent activity by members, providers, employees and other parties against the Company and deciding the most effective and efficient method of investigation

* Maintaining accurate, current and thorough case information in the SIU Case Tracking Database

* Securing documentation, either internally or externally, and preparing summaries of the findings from the documentation

* Documenting the evidence and drawing conclusions based on the investigative findings and preparing summaries of the investigative findings and case outcome

* Representing the Company in conducting settlement negotiations

* Gathering objective evidence in support of investigation outcomes

* Collecting, collating, analyzing and interpreting data, both internally and externally, relating to fraud, waste and abuse referrals

* Controlling and maintaining Company and departmental data to ensure confidentiality in accordance with the Data Release Governance Program

* Reporting suspected fraud, waste and abuse to appropriate federal or state government regulators

* Attending at least 24 hours of continuing anti-fraud training annually

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:

* Bachelor's degree in Criminal Justice or related field or Associate's degree and 2 years of experience with healthcare related employment

* Experience analyzing and interpreting data to identify trends, patterns, and generate leads for the team

Preferred Qualifications:

* CPC, AHFI or CFE

* Experience within a healthcare Special Investigations Unit

* Knowledge of medical terminology

* Knowledge of medical coding (CPT, HCPCS, ICD-9, ICD-10)

* Intermediate level of proficiency in MS Excel and MS Word

* Intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to healthcare fraud

* Detail oriented with excellent organizational and analytical skills

* Ability to communicate effectively both verbally and in writing

* Strong listening and writing skills

* Independent, reliable and responsible

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas 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. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

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

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: Senior Investigator, Data, Excel, Access, Analyst, Data Investigator, Telecommute, Telecommuting, Telecommuter, Work From Home, Remote, Metairie, Baton Rouge, LA, Louisiana