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Investigations Consultant - Multiple Locations, TX

UnitedHealth Group


Location:
San Antonio, TX
Date:
09/05/2017
2017-09-052017-10-04
Job Code:
1774147
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Job Details


Investigations Consultant - Multiple Locations, TX(Job Number:725616)
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, employees 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:

  • Identify gaps and inefficiencies in existing policies and procedures and suggest effective and efficient solutions
  • Investigative Consultant will verify the validity of all addresses associated to a High-Risk Laboratory including, but not limited to, Google Maps searches and / or on-site visits
  • Investigative Consultant will perform background checks on all employees / entities, as well as further analytics to identify past/present association(s) with laboratory terminated from the Network and / or engagement in FWA activity
  • Investigative Consultant will validate one (1) years’  worth of invoices and / or other applicable documentation, as well as correlating billing records
  • Investigative Consultant will verify current laboratory equipment, including purchase orders and serial numbers
  • Investigative Consultant will execute unannounced Laboratory inspections, to ensure compliance with state and / or federal regulations, codes and statutes
  • Obtain and analyze claims billing and payment data as necessary in the course of conducting complex investigations of allegations of criminal or civil fraud
  • Testify in criminal, civil and / or administrative proceedings as required
  • Interview witnesses who have knowledge of alleged fraud/abuse activity
  • Prepare comprehensive case investigation reports including evidence and findings

Job Special Investigation Unit
Primary Location US-TX-San Antonio
Other Location US-TX-Dallas, US-TX-Houston, US-TX-Austin
Organization UHC LCRA - Compliance
Schedule Full-time
Number of Openings 1
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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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