Kansas Works Jobs

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 to start Caring. Connecting. Growing together.

The Principal Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste, and abuse. They will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. They are responsible to conduct investigations which may include fieldwork to perform interviews and obtain records and/or other relevant documentation.

• Schedule Monday-Friday, standard business hours

• Travel 25%

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 reside in the state of Kansas, You’ll enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Assess complaints of alleged misconduct received within the Company

• Investigate 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

• 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 workgroups or regulatory meetings

• Communicate effectively, to include written and verbal forms of communication

• Develop goals and objectives, track progress and adapt to changing priorities

• Must participate in legal proceedings, arbitration, and depositions at the direction of management

What are the reasons to consider working for UnitedHealth Group? Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays

• Medical Plan options along with participation in a Health Spending Account or a Health Saving account

• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage

• 401(k) Savings Plan, Employee Stock Purchase Plan

• Education Reimbursement

• Employee Discounts

• Employee Assistance Program

• Employee Referral Bonus Program

• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

• More information can be downloaded at: http://uhg.hr/uhgbenefits

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:

• Associate's degree or higher

• 5+ years of experience in health care fraud, waste and abuse (FWA)

• 5+ years of experience in state or federal regulatory (FWA) requirements

• 5+ years of experience with analyzing data to identify fraud, waste and abuse (FWA) trends

• 5+ years of experience in Microsoft Excel and Word

• 2+ years of experience with healthcare related employment

• Ability to travel (drive/fly) up to 25% of the time

• Valid Drivers License in the state of Kansas

• Reside in the state of Kansas

Preferred Qualifications:

• 5+ years of experience with health care policies, procedures, and documentation standards

• 5+ years of experience with developing investigative strategies

• Specialized knowledge/training in healthcare FWA investigations

• Accredited Health Care Fraud Investigator (AHFI)

• Certified Fraud Examiner (CFE)

• Certified Professional Coder (CPC)

• Medical Laboratory Technician (MLT)

• Advanced knowledge and experience in Statistical Analysis Software (SAS), Python, Tableau, Toad, Structured Query Language (SQL), Visual Basic for Applications (VBA), or Alteryx

• Advanced knowledge and experience in Statistical Analysis, Regression Analysis, Linear Analysis, or Market-basket Analysis

• License and/or Certified Pharmacy Technician (CPhT)

• Basic knowledge in pharmacy claims processing

• Operational experience with a pharmacy and/or pharmacy benefits manager (PBM)

*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.

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