Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
If you are located in the state of New York, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- Investigate, review, and provide data-trend expertise in a review of post-service, pre-payment or post-payment claims
- Identifies overt billing trends for Fraud, Waste, Abuse, and/or Error identification, and recommends providers to be flagged for review or identify claims for recovery
- The Forensic accountant will advise audit teams on evaluating fraud risk, raise the level of anti-fraud capability amongst the general audit population and provide guidance on internal controls designed to prevent, deter, or detect the risk of fraud or misconduct and will support compliance with applicable laws and regulations
- Communicate the results of your analysis clearly and concisely, in both written and verbal forms, to internal, supplier and client personnel
- Work independently, often balancing work activities between multiple audits, ensuring each project continues to progress toward timely completion
- Establish, track, maintain and store results within an interactive database for future reference
- Collect and analyze data and documents received from our clients and other sources to assess provider compliance with contractual provisions
- Conducts forensic analysis of financial data
- Assessing losses and potential damage awards
- Applying knowledge of financial accounting practices
- Interpretation of state and federal mandates, billing practices/patterns, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with overt billing patterns and make recommendation decisions based on findings
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:
- 5+ years experience in Healthcare Fraud, Waste, Abuse and/or White collar crime Investigations Experience in Forensic Investigation
- Solid analytical skills with ability to research issues, identify root causes and recommend solutions
- Solid aptitude and interest in data analysis
- Proven outstanding written and oral communication skills
- Proven time management skills, with ability to plan tasks and self-manage work to completion
Preferred Qualifications:
- Degree in Accounting or CPA
- CFE/AHFI
- Knowledge with litigation support and research
- Proficiency with Microsoft Excel required, proficiency with Microsoft Access a big plus
- Developing knowledge of auditing, statistical analysis and forensic investigative techniques
- Working knowledge of accounting and finance principles
Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
New York Residents Only: The salary range for New York residents is $67,800 to $133,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work... Read more