Pharmacy Investigator - Remote in MI
Pharmacy Investigator - Remote in MI
UnitedHealthcare
Lansing, MI
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At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Pharmacy Investigator reports directly to the Manager of Investigations, and is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Pharmacy Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Pharmacy Investigator is responsible for conducting investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.
You'll enjoy the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities
Required Qualifications
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.
#RPO #Yellow
The Pharmacy Investigator reports directly to the Manager of Investigations, and is responsible for identification, investigation and prevention of healthcare fraud, waste and abuse. The Pharmacy Investigator will utilize claims data, applicable guidelines and other sources of information to identify aberrant billing practices and patterns. The Pharmacy Investigator is responsible for conducting investigations which may include field work to perform interviews and obtain records and/or other relevant documentation.
You'll enjoy the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities
- Investigate medium to highly complex cases of fraud, waste and abuse
- Detect fraudulent activity by members, providers, employees and other parties against the Company
- Develop and deploy the most effective and efficient investigative strategy for each investigation
- Maintain accurate, current and thorough case information in the Special Investigations Unit’s (SIU’s) case tracking system
- Collect and secure documentation or evidence and prepare summaries of the findings
- Participate in settlement negotiations and/or produce investigative materials in support of the later
- Collect, collate, analyze and interpret data relating to fraud, waste and abuse referrals
- Ensure compliance of applicable federal/state regulations or contractual obligations
- Report suspected fraud, waste and abuse to appropriate federal or state government regulators
- Comply with goals, policies, procedures and strategic plans as delegated by SIU leadership
- Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at work-groups or regulatory meetings
- Travel 50% or more in the greater Detroit, MI area
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- More information can be downloaded at: http://uhg.hr/uhgbenefits
Required Qualifications
- Bachelor’s degree OR Associate’s degree with 2+ years of healthcare-related experience
- Intermediate level of proficiency in Microsoft Excel and Word
- Intermediate level of knowledge with local, state/federal laws and regulations pertaining to healthcare fraud, waste and abuse (FWA)
- Willing and able to travel 50% or more of the time in the greater Detroit, MI area
- Specialized knowledge/training in healthcare FWA investigations
- Active affiliations:
- National Health Care Anti-Fraud Association (NHCAA)
- Accredited Health Care Fraud Investigator (AHFI)
- Certified Fraud Examiner (CFE)
- License and/or Certified Pharmacy Technician (CPhT)
- Intermediate knowledge in pharmacy claims processing
- Operational experience with a pharmacy and/or pharmacy benefits manager (PBM)
- 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.
#RPO #Yellow
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Seniority level
Entry level -
Employment type
Full-time -
Job function
Other, Information Technology, and Management -
Industries
Hospitals and Health Care
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