Investigations Consultant- Telecommute within California
Company: UnitedHealthcare LCRA
Location: Los Angeles
Posted on: June 14, 2018
There's no sugar coating it, fraud is rampant in health care. And with a projected total spend at nearly $3 trillion, the stakes couldn't be higher. But it's not just the financial losses that we're worried about. We're in the business of making the health care system work better for everyone, so the abuse impacts millions of lives too. As a Lead Investigator, you'll review claims, look for patterns of potential fraud, waste and/or abuse and interact with medical providers to complete investigations. You'll be fully invested in the outcomes and will be helping the health system work better for everyone with the support and resources of a Fortune 6 industry leader. If you are located in California, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities Conduct confidential investigations, document relevant findings and report any illegal activities in accordance with all laws and regulations Conduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation Serve as a team lead, assisting other team members in researching and investigating potential fraud, waste and/or abuse cases Analyzing the sheer magnitude of investigative findings will be the toughest part of your role You will serve as a subject matter expert in uncovering common themes, recovery and testimonials You will do limited field work, primarily reporting on patterns trending in investigationsRequired Qualifications Undergraduate degree or equivalent work experience 3+ years of healthcare investigations experience An intermediate level of proficiency in MS Excel and Word An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to insurance Ability to travel up to 25% of the time Must live within the state of CA Preferred Qualifications Investigative experience within medical claims Undergraduate degree in the area of Criminal Justice or related field MS Access experience Certifications: Accredited Healthcare Fraud Investigator (AHFI) , Certified Fraud Examiner (CFE) , Certified Professional Coder (CPC) Experience with Medical, Fraud Waste and Abuse (FWA) Every day, we work to make communities healthier. It's the promise that is at the core of who we are. And our employees' expertise makes all the difference in achieving our goal. Join our elite team today and start doing your life's best work.(sm)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 Groups 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: Investigations, Accredited Healthcare Fraud Investigator (AHFI) , Certified Fraud Examiner (CFE) , Certified Professional Coder (CPC), Medical, Fraud Waste and Abuse (FWA), Local, State & Federal laws and regulations, law enforcement investigation, insurance claims, Investigate, Prevent and Enforce Violations, Health Care Fraud Investigator, specializing in Medical/Provider Fraud, California, CA
Keywords: UnitedHealthcare LCRA, Los Angeles, Investigations Consultant- Telecommute within California, Professions, Los Angeles, California
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