Investigations Data Consultant - Telecommute
Iselin, NJ 
Posted Today
Job Description

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

There's no sugar coating it - fraud is rampant in health care. And with a projected total spend at nearly $3 trillion, the stakes couldn't be higher. But it's not just the financial losses that we're worried about. We're in the business of making the health care system work better for everyone, so the abuse impacts millions of lives too. As a Lead Investigator, you'll review claims, look for patterns of potential fraud, waste and/or abuse and interact with medical providers to complete investigations. You'll be fully invested in the outcomes and will be helping the health system work better for everyone with the support and resources of a Fortune 10 industry leader.

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

Primary Responsibilities:

  • Establish, mandate and implement standard policies, procedures and best practices regarding UnitedHealthcare Investigations' claim sampling and extrapolation methodologies and other tasks as delineated by UnitedHealthcare Investigations' Leadership.
  • Support and perform the collection of data for investigation needs, identify investigative data universe, perform statistically valid random sampling, coordinate and develop reports, projects, using well established knowledge of health care related data manipulation tools.
  • Predict and detect emerging health care fraud trends and develop innovative technological solutions to identify them
  • Conduct state and federal legal research and monitor changes in requirements to mitigate risks and achieve compliance
  • Develop compliance communications and drive problem resolution for a business segment across UnitedHealth Group
  • Assist other team members in researching and investigating potential fraud, waste and/or abuse cases

Analyzing the sheer magnitude of investigative findings will be the toughest part of your role. You will serve as a subject matter expert in uncovering common themes, recovery and testimonials. You will do limited field work, primarily reporting on patterns trending in investigations.

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:

  • Bachelor's degree in Mathematics, Statistics and/or areas of related study
  • 5+ years of experience working in a government, legal, health care, managed care and/or health insurance environment in a regulatory, privacy, compliance, or investigations role
  • Experience communicating complex information via phone conversations and emails to non-technical clients, external customers, internal customers and executives
  • Experience interacting and collaborating with a variety of stakeholders (other team members, internal customers, and executives)
  • Intermediate or better proficiency with MS Word, MS Outlook, MS Access
  • Intermediate or better proficiency with at least one of the following: SQL, SAS, VBA
  • Advance proficiency with MS Excel
  • Knowledge of Statistical Sampling Tools (example - RAT STATS) and methodologies
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

  • Experience working with Medicare, Medicare Advantage, Medicare Part D, Medicaid and/or Tricare regulations
  • Familiarity with "big" data manipulation tools such as SAS, Toad, Python, Tableau, Alteryx etc.
  • Familiarity with statistical tools in healthcare
  • Familiarity with software engineering

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 10 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*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: fraud, waste, abuse, law, legal, enforcement, investigator, investigate, investigations, Medicare, Part D, Medicaid, Tricare, health, health care, healthcare, claims, Facets, iDRS, CSP, Macess, coding, examiner, data, Access, Excel, VBA, SQL, SAS, Toad, Python, Tableau, Alteryx, mathematics, statistics, Rat STATS, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote


Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
5+ years
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