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Investigations Consultant - Florida or California Telecommute

UnitedHealth Group


Location:
Miami, FL
Date:
12/12/2017
2017-12-122018-01-10
Job Code:
742021
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Job Details

742021 Investigations Consultant Florida or California Telecommute

Investigations Consultant - Florida or California Telecommute (742021)

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 Investigations Consultant will be responsible for triaging, 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 Consultant 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 with identifying, communicating and recovering losses as deemed appropriate. Where applicable, they will provide testimonials regarding the investigation.

 

If you are located in Florida or California, you will have the flexibility to telecommute* as you take on some tough challenges.

Required Qualifications:

  • Bachelor's degree in the area of Criminal Justice or related field
  • 5+ years of experience with investigations
  • 5+ years of experience with the group health business
  • 5+ years of experience within the insurance claims industry
  • Experience with on - site investigations
  • Experience with in - person interviews
  • An intermediate level of proficiency in MS Excel, MS Word and MS Access
  • An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to insurance

Preferred Qualifications:

  • Southern Florida / Miami area candidate or Los Angeles area candidate

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: Investigations, Claims, Miami, FL, Florida, Los Angles, CA, California

Job Details

  • Contest Number742021
  • Job TitleInvestigations Consultant - Florida or California Telecommute
  • Job FamilyRegulatory and Compliance
  • Business SegmentOptum Operations

Job Location Information

  • Miami, FL
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • 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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