12 days old

Senior Healthcare Reviewer and Investigator - Boise, ID

Boise, ID 83702
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Optum, a UnitedHealth Group company, with over 125,000 employees globally, specializes in tackling the biggest challenges in health care by partnering across the entire system. Together, we are transforming health care for a better future for everyone we serve.  Here's a statistic that will stop you cold: our country will spend more than $8 trillion on health care in 2020. With that kind of money at play, you can be sure some individuals will figure out a way to get a piece of it illegally. Now, that doesn't even take into account the millions of lives that are held in the balance as well. This is fraud on a scale you couldn't begin to imagine. As a Senior Investigator, you will play a part in putting a stop to it. It's critical work that you will want to be a part of, and we're a place like no other and where you'll do your life's best work.(sm)

Our Senior Investigators work on elite Avoidance Investigations Units (AIUs) / Special Investigations Units (SIUs), dedicated to identifying, investigating and eliminating healthcare fraud. You will be part of a team responsible for investigating and resolving instances of healthcare fraud and/or abusive conduct. You will spend your time conducting investigations and putting together your findings.  This is an office-based position for our Boise, ID location. In this role, you will work collaboratively with Idaho state employees, and conduct onsite visits / audits and obtain medical records as part of investigations to validate provider claims.

Part of our screening and selection process involves completing a HireVue video interview and a pre-interview questionnaire for consideration.

Primary Responsibilities:

  • Investigating and resolving instances of healthcare fraud, waste, and / or abusive conduct

  • Conduct telephonic interviews of members, providers, and/or additional contacts to gather information to support investigation

  • Review claims data and conduct analysis to look for patterns of potential fraud, waste and/or abuse

  • Utilizing information from claims data analysis, plan members, and other sources to conduct confidential investigations, document relevant findings and report any illegal activities in accordance with all laws and regulations

  • Conduct investigations to review claim and case history

  • Potentially conduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation

  • Collaborate and analyze all information gathered from our onsite team to document additional facts related to the investigation

  • Gather information pertinent to the case and provide testimonials regarding the investigation

  • Support Compliance, Regulatory, Legal, and Law Enforcement on case actions


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.

Posted: 2020-10-08 Expires: 2020-11-08

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Senior Healthcare Reviewer and Investigator - Boise, ID

UnitedHealth Group
Boise, ID 83702

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