Investigations Data Consultant - Telecommute in LA

Company: UnitedHealth Group
Location: Baton Rouge
Posted on: June 22, 2022

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)As an Investigations Data Consultant, you'll review claims data, look for patterns of potential fraud, waste and/or abuse and interact with the Special Investigations Unit ("SIU") 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 5 industry leader. -If you are located witihin the state of LA, you will have the flexibility to telecommute* 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 casesAnalyzing 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 investigation's 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, SQL, SAS and VBA
  • Advance proficiency with MS Excel and Statistical Sampling Tools (example - RAT STATS) and methodologies
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodationPreferred 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 engineeringTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employmentCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 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)*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.

Keywords: UnitedHealth Group, Baton Rouge , Investigations Data Consultant - Telecommute in LA, Professions , Baton Rouge, Louisiana