[Hiring] Senior Recovery Resolution Analyst @UnitedHealth Group

Role Description

Employees are responsible for triaging, investigating, and resolving potential instances of healthcare fraud and/or abusive conduct by medical professionals or providers. Using information from tips, complaints, external intelligence or behavior data, the medical community and law enforcement, employees conduct confidential investigations and document relevant findings and report any illegal activities in accordance with all laws and regulations. Identify, communicate, and recover losses as deemed appropriate. These investigations may include participation in telephone calls or meetings with providers, members, clients, legal compliance, and other investigative areas and requires adherence to state and federal compliance policies, reimbursement policies, and contract compliance.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Gather and analyze data and information gathered to determine behavior and understand provider/scheme at issue
• Utilize appropriate documentation and tracking controls in the case tracking system to ensure compliance and auditability requirements are met
• Collaborate with SIU Lead Investigator to apply knowledge of coding guidelines to determine validity of aberrances
• Collaborate with a variety of external sources to identify current and emerging patterns and schemes related to FWA
• Perform member and provider interviews, and review medical documentation as needed
• Communicate with legal, Law Enforcement, clients and business partners as needed
• Perform all other duties as assigned

Qualifications

• High School Diploma/GED and 5+ years of experience working in a FWA / SIU or Fraud investigations role OR Associate’s degree in Criminal Justice or experience in a related field
• Certified Professional Coder (CPC)
• 2+ years of experience within the health insurance claims industry
• 1+ years of knowledge and/or experience with medical/behavioral health codes and service delivery
• Intermediate level of proficiency in Microsoft Excel (pivot tables and macros) and Word (creating, editing, and saving documents)

Requirements

• 2+ years of experience working with law enforcement or legal entities or 3+ years of investigative experience with fraud investigations
• Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar
• Familiar with CPT code terminology
• Experience with computer research
• Experience with regulatory compliance
• Experience with data analysis as it relates to financial recovery/settlements

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

Company Description

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.