Investigator

Requisition Number: 2367444
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Investigator will be responsible for investigating agent/broker complaints across all lines of business in accordance with state and federal regulations.
Travel 0-10%.
Schedule: Monday-Friday, standard business hours. No nights, no weekends and no holidays!
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:

• Conduct confidential compliance investigations related to Agents/Brokers across all lines of business
• Document all relevant findings in written reports
• Utilize information from plan members (interviews), agents/brokers, sales operations, claims data, and internal systems
• Conduct and document interviews (on telephone and in person) for all parties involved in an investigation
• Report any illegal activities in accordance with all laws and regulations
• Act as a subject matter expert with identifying and communicating relevant findings to the business
• Where applicable, provide testimony regarding the investigation
• Responsible for generating independent work product

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:

• High School Diploma/GED
• 2+ years of experience working independently and researching/conducting investigations
• 1+ years of experience in a position investigating fraud (health care fraud investigations experience preferred)

Preferred Qualifications:

• Bachelor's degree in criminal justice or related field
• 2+ years of experience working in the group health business preferred, health insurance sales or sales compliance
• An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, and/or commercial health insurance)
• Experience with Facets, or other claims processing systems
• Certified Fraud Examiner preferred

*All Telecommuters 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 $49,700 to $88.800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
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.
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.
#RPO #GREEN