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Investigations Consultant - Iselin, NJ

UnitedHealth Group


Location:
Iselin, NJ
Date:
06/23/2017
2017-06-232017-07-22
Job Code:
1749209
Apply on the Company Site
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Job Details


Investigations Consultant - Iselin, NJ(Job Number:714925)
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.

 

Primary Responsibilities:

  • Triage, investigate and resolve instances of healthcare fraud and/or abusive conduct by the medical profession, insured members or the broker community
  • Conduct data analysis and case generation activities
  • Utilize information from claims data analysis, plan members, employees’ conduct confidential investigations and document relevant findings
  • Report any illegal activities in accordance with all laws and regulations
  • Conduct onsite provider claim and / or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation
  • Act as a subject matter with identifying, communicating and recovering losses as deemed appropriate
  • Provide testimonials regarding the investigation

 


Job Special Investigation Unit
Primary Location US-NJ-Iselin
Other Location 
Organization UHC LCRA - Compliance
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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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