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Healthcare Claims Investigator - Brentwood, TN

UnitedHealth Group

Brentwood, TN
Job Code:
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Job Details

737847 Healthcare Claims Investigator Brentwood TN

Healthcare Claims Investigator - Brentwood, TN (737847)

Position Description

Position Description:


Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return, we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work.(sm)


The roles in this function are not within claims and underwriting. May also complete root cause analysis.


Primary Responsibilities:

  • The Investigator will be responsible for investigating and resolving instances of healthcare fraud and / or abusive conduct by the medical profession, insured members or the broker community.
  • This individual will be utilizing information from claims data analysis, plan members, employee's conduct confidential investigations and document relevant findings.
  • They will report any illegal activities in accordance with all laws and regulations.
  • The Investigator may also conduct onsite provider claim and / or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation.
  • They will act as a subject matter expert with identifying, communicating and recovering losses as deemed appropriate.
  • Where applicable, they will provide testimonials regarding the investigation.
  • Analyzes and investigates.
  • Provides explanations and interpretations within area of expertise.

Required Qualifications:

  • Associate's Degree (or higher) in Criminal Justice or related field OR High School Diploma / GED with 2+ years of experience working in fraud investigations.
  • 1+ years of experience within the insurance claims industry   
  • Experience in Microsoft Excel (formulas, graphs, pivot tables) and Microsoft Word (create and edit documents)
  • 1+ years of experience working with payment integrity   

Preferred Qualifications:

  • Experience with law enforcement investigation
  • Experience with the group health business, particularly within claims processing or coding
  • Knowledge of Local, State & Federal laws and regulations pertaining to Medicaid and Medicare
  • Medical Coding Certification

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


Diversity creates a healthier atmosphere: 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.


Keywords: UHG, Optum, healthcare claims, investigation, healthcare fraud, criminal justice, payment integrity 

Job Details

  • Contest Number737847
  • Job TitleHealthcare Claims Investigator - Brentwood, TN
  • Job FamilyRegulatory and Compliance
  • Business SegmentOptum Operations

Job Location Information

  • Brentwood, TN
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

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.

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