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UnitedHealth Group

Post Pay Senior Investigator - Telecommute U.S

UnitedHealth Group - Hopkins, MN

Post Pay Senior Investigator - Telecommute U.S.

Job Description

Position Description

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)

The Post-Pay Senior Investigator

will work with a team on researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules.

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

Primary Responsibilities:

Perform enhanced provider verification / phantom investigation on tips / allegations to identify potential Fraud, Waste, Abuse, or Error (i.e. internet research, review claims history on various platforms and FWAE databases), based on applicable Job Aid

Perform member and provider interviews, and review medical documentation as needed

Document in a professional manner the investigation activities that were performed on tips / allegations

Adjust claims as needed based on investigation performed

Refer tip / allegation to the appropriate internal team

Communicate with clients and business partners as needed

Submit CMS reporting as required

Ensure adherence to state and federal compliance policies and reimbursement policies

Adhere to turn around time standards

Meet and maintain minimum quality and productivity standards

Sought out as an expert

Handle more complex tasks (e.g. medical record review, C&S clients, escalations, special requests from other departments)

Required Qualifications:

College Degree with 4 years of criminal justice, legal, insurance, lab, or fraud investigation experience OR High School diploma / GED with 5 years of criminal justice, legal,insurance, lab, or fraud investigation experience

2 years of insurance experience with one or more of the following: claim processing, provider demographic information or insurance billing practices

1 years of experience with CPT coding / medical record review

Intermediate level experience with Microsoft Office tools (including Pivot tables in MS Excel)

2 years in criminal justice, legal or fraud investigation

Preferred Qualifications:

Experience working in claims systems / platforms

Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI) or similar

Experience in solving complex problems by utilizing computer research

Careers with Optum.

Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to 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: Post-Pay Senior Investigator, Investigator, CPT, Fraud, CFE, AHFI, Telecommute, Telecommuter, Telecommuting, Remote, Work from home


Job Reference #:


11 days 19 hours ago

UnitedHealth Group


Post Pay Senior Investigator - Telecommute U.S UnitedHealth Group - Hopkins, MN, United States


Location: Hopkins, MN

Company Profile:
About UnitedHealth Group UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone. We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term