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
The Sr. Investigator will be responsible for investigating agent/broker complaints across all lines of business in accordance with state and federal regulations.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
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) OR 5+ years of investigative experience
- 3+ years of investigative experience, preferably within Medicare/Medicaid
- 2+ years of experience with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, Affordable Care Act Plans, and/or commercial health insurance)
- Basic level of proficiency in MS Excel and MS Word
Preferred Qualifications:
- Fraud Certification, such as CFE of AHFI
- Experience directly in Healthcare/Insurance related Compliance, Investigations or Operations
- Experience with interviewing agents and members
- Experience within Medicare/Medicaid insurance fraud
- Experience with investigative data bases
- Familiarity with MS Access
Soft Skills:
- Experience communicating complex information both verbally and in written form
- Excellent verbal and written communication skills
Careers 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.
California, Colorado, Connecticut, Nevada, New York, Washington or Rhode Island Residents Only: The salary range for California, Colorado, Connecticut, Nevada, Washington or New York City residents is $56,300 to $110,400. 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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