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Payment Integrity / Fraud Lead - Boston, MA

UnitedHealth Group

Boston, MA
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Job Details

751577 Payment Integrity Fraud Lead Boston MA

Payment Integrity / Fraud Lead - Boston, MA (751577)

Position Description

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

Primary Responsibilities:
  • Managing the operational activities of 10-15 staff who conduct the tasks responsible for the end to end Government FWAE activities using internal applications and external client claim platforms and systems
  • Manage key client relationship in Massachusetts focusing on LTSS services to achieve savings targets.   These activities include strategic planning, thought partnership, program management, client management, compliance audit support, post pay investigations, medical record reviews, provider inquiry resolution, responding to client questions, and client implementation and growth activities

**Location Requirement: Position must be located in the Boston area

**Travel Requirements - Travel is based on client need.  Client located in Boston, MA.  May require up to 80% travel to client site at MA state offices


Required Qualifications:
  • Bachelor’s Degree        
  • 10 or more years of experience managing mid-large scale projects including staff, budget and timelines, deliverables and client management experience
  • 7 or more years of experience working with Massachusetts state health policy and programs
  • 6 or more years of experience in Payment Integrity
  • 8 or more years of Client Management Experience (direct client facing support)
  • 5 or more years of Leadership Experience (having direct reports)
Preferred Qualifications:
  • Graduate Degree / MBA
  • Project Management Experience
  • MA LTSS (Long Term Support Service) experience
  • Experience in Fraud and Abuse delivery
  • Expertise in any of the following areas: program integrity, policy analysis, program evaluation, program integrity, informatics, strategic planning and process improvement
  • Proficient in leading cross-functional project teams
Soft Skills:
  • Proven client engagement and effective client relationship building both internal and external
  • Identify and solve problems that impact the management and direction of the program
  • Develop strategic plans that impact the long-term success of the program and provide strategic input to the development of program roadmap and timelines 
  • Create supporting collateral materials and support for audit efforts with clinical staff
  • Provide leadership relative to solution ideation, creation, development, and implementation
  • Provide general healthcare consulting services
  • Achieving client specific revenue targets
  • Identify opportunities for sales and business development collaboration with other Optum business segments
  • Provide thought leadership and thought partnership  in collaboration with client
  • Ensure quality assurance methods are implemented within the program
  • Provide status updates and review of programs to client and senior leadership. Provide coaching and mentoring of project team with the goal of developing and retaining talent within the organization.
  • Create a team oriented work climate that enables professional development and encourages creative solutions and strategies
  • Ability to build consensus and foster change in a client business setting

**Location Requirement: Position must be located in the Boston area

**Travel Requirements - Travel is based on client need.  Client located in Boston, MA.  May require up to 80% travel to client site at MA state offices.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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:  Payment, Integrity, Fraud Lead, Boston, MA, Massachusetts     


Job Details

  • Contest Number751577
  • Job TitlePayment Integrity / Fraud Lead - Boston, MA
  • Job FamilyBusiness Operations
  • Business SegmentOptum Operations

Job Location Information

  • Boston, MA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelDirector
  • 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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