Senior Fraud Waste Abuse Analyst CPC or CFE - Remote

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
The Fraud, Waste, and Abuse (FWA) Senior Data Analyst plays a critical role in safeguarding state Medicaid programs by identifying, analyzing, and preventing fraudulent activities within Medicaid claims. You will be working with a State Government Product and Data Mining team. Your primary responsibility will be to assist in the development and deployment of algorithms designed to support program integrity across various platforms and states plus support our fraud and abuse detection product and services.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities:

• Write simple to complex SQL statements to extract data for client inquiry and research
• Utilize production reports to perform research and assess quality of overall data
• Analyze and interpret data to identify FWA trends and patterns within claims data
• Applies creative and analytical thinking to uncover and resolve complex fraud, waste, and abuse patterns
• Engage with clients to triage and manage incoming operational inquiries and tasks
• Identifies innovative approaches to resolve non-standard problems and deliver effective outcomes
• Interface professionally with data engineers, software engineers and other development teams
• Troubleshoot client operational issues quickly and comprehensively
• Support, train and mentor fellow analysts and developers
• Influences and provides input to improvement of operational processes

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:

• Certified Professional Coder (CPC) or Certified Fraud Examiner (CFE)
• 5+ years of fraud, waste and abuse data mining experience
• 5+ years of experience writing advanced SQL queries
• 4+ years of data analysis experience working with database structures
• 4+ years of healthcare claims experience
• Proficiency with excel & visualization tools
• Proficient in research, interpreting, and analyzing diverse and complex data, and assessing data quality
• Intermediate to advanced computer skills consisting of Teams, Microsoft Excel, Outlook, Word, and Power Point
• Ability to travel 10%

Preferred Qualifications:

• Experience with statistical analysis of data
• Experience with Rally
• Knowledge of Medicaid policy and real-life fraud, waste, abuse schemes
• Knowledge of healthcare claim adjudication systems

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.