UnitedHealth Group

UnitedHealth Group.

  • Metairie, LA


  • Long-term.

  • Full-time.

Bring us your experience, your head for method, your strength with relationships and your eye for chance. In return we provide an unrivaled location to grow and establish your profession amongst a highly varied group of companies driven by the power and stability of a leading healthcare company. Come assist us recover and reinforce the healthcare system as you do your life’s finest work.( sm)

The Investigations Specialist will be accountable for recognition, examination and avoidance of health care scams, waste and abuse. This person will make use of claims information, medical coding standards and their eager eye to recognize abhorrent medical billing practices and patterns. They will be accountable to carry out examinations which might consist of field work to carry out interviews and acquire medical records/and other appropriate documents, The Examinations Specialist will likewise function as subject professional in investigating and interacting their findings both orally and in composing and will be accountable to report any prohibited activities in accordance with all appropriate laws.

The SIU Principal Private investigator reports straight to the SIU Supervisor. The main duty of the Principal Private investigator is to examine the most intricate cases of scams, waste and abuse.

Main Duties:

  • Discovering deceptive activity by members, companies, workers and other celebrations versus the business and choosing the most efficient and effective technique of examination
  • Preserving precise, existing and comprehensive case info in the SIU Case Tracking Database
  • Protecting documents, either internally or externally, and preparing summaries of the findings from the paperwork
  • Recording the proof and reasoning based upon the investigative findings and preparing summaries of the investigative findings and case result
  • Representing the Business in performing settlement negotiations
  • Collecting unbiased proof in assistance of examination results
  • Collecting, looking at, evaluating and analyzing information, both internally and externally, associating with scams, waste and abuse recommendation
  • Controlling and keeping Business and department information to make sure privacy in accordance with the Data Release Governance Program
  • Reporting believed scams, waste and abuse to suitable federal or state federal government regulators
  • Leading unique tasks
  • Preparing reports of SIU activity to help the SIU Supervisor in discussion of last reports to the Board of Directors, the state and regulative firms, the health insurance or UHC Elder Management
  • Helping the SIU Supervisor in execution of the Supervisor’s duties in the Supervisor’s lack
  • Participating in a minimum of 24 hours of continuing anti-fraud training every year

You’ll be rewarded and acknowledged for your efficiency in an environment that will challenge you and offer you clear instructions on what it requires to be successful in your function along with supply advancement for other functions you might have an interest in.

Needed Certifications:

  • Bachelor’s degree in the location of Lawbreaker Justice, Organization, or associated field
  • 5 years of experience working in a federal government, legal, healthcare, handled care and/or medical insurance environment in a regulative, personal privacy, compliance, or examinations function
  • Intermediate or higher performance of understanding with Regional, State & Federal laws and policies referring to health care scams
  • Intermediate level of efficiency in MS Excel and MS Word
  • Need to live within a commutable range of Metarie or Baton Rouge, LA

Preferred Credentials:

  • CPC, AHFI or CFE
  • Experience within a health care Unique Examinations System
  • Understanding of medical terms
  • Understanding of medical coding (CPT,HCPCS,ICD-9, ICD-10)
  • Information oriented with exceptional organizational and analytical abilities
  • Capability to interact successfully both verbally and in composing
  • Strong listening and composing abilities
  • Independent, reputable and accountable

Professions with UnitedHealthcare. Let’s discuss chance. Start with a Fortune 5 company that’s serving more than 85 million individuals currently and constructing the market’s particular track record for vibrant concepts and flawless execution. Now, include your energy, your enthusiasm for quality, your near-obsession with driving modification for the much better. Understand? UnitedHealthcare is serving companies and people, states and neighborhoods, military households and veterans where ever they’re discovered around the world. We bring them the resources of a market leader and a dedication to enhance their lives that’s 2nd to none. This is no little chance. It’s where you can do your life’s finest work.( sm)

To learn more on our Internal Task Post Policy,.

Variety develops a much healthier environment: UnitedHealth Group is an Equal Work Opportunity/Affirmative Action company and all certified candidates will get factor to consider for work without regard to race, color, faith, sex, age, nationwide origin, secured experienced status, special needs status, sexual preference, gender identity or expression, marital status, hereditary info, or any other particular secured by law.

UnitedHealth Group is a drug – totally free office. Prospects are needed to pass a drug test prior to starting work.

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UnitedHealth Group.

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