Job: Sr Investigator - Richmond, VA or Sunrise, FL

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Jobing Description

The Senior Investigator will be responsible for triaging, investigating and resolving instances of healthcare fraud and/or abusive conduct by the medical profession, insured members or the broker community. This individual will be utilizing information from claims data analysis, plan members, employee's conduct confidential investigations and document relevant findings. They will report any illegal activities in accordance with all laws and regulations. The Senior Investigator may also conduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation. They will act as a subject matter with identifying, communicating and recovering losses as deemed appropriate. Where applicable. they will provide testimonials regarding the investigation.
Will primarily be responsible for GCA reporting for Southeast

Skills / Requirements

Requirements:
- Associates Degree in the area of Criminal Justice or related field
- 4+ years experience within the medical insurance/healthcare claims industry required (claims billing, coding, processing, auditing)

- Must be able to look at medical claims forms and understand coding

- Previous experience working in medical healthcare fraud
- A basic level of proficiency in MS Excel, MS Word and MS Access.
- An intermediate level of knowledge with Local, State and Federal laws and regulations pertaining to health insurance required.
- Excellent verbal and written communication skills.

Preferred Skills:
- 4+ years experience with the group health business preferred, particularly within claims
- Undergraduate degree

OptumInsight is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

OptumInsight is one of the largest and fastest growing health information companies. We specialize in improving the performance of the health system by providing analytics, technology and consulting services that enable better decisions and results. We integrate workflow solutions that deliver data in real-time, and create actionable insights - processing health information that relates directly to and affects one in four patients in the U.S, one in every three Medicaid dollars and one in every five emergency room visits. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. No matter what your role is at OptumInsight, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever. It's always fresh. It's always exciting. And it's never been more important.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V