No other industry is changing as rapidly or as broadly as health care. But to us, change is invigorating. It gives us a chance to continue to innovate as we shape the future. As a Compliance Consultant with us, you will monitor industry standards and changes in statistical sampling methodologies in health care. You will conduct analysis using large sets of claim and cost data in support of on-going fraud investigations and case ideation. Meet and engage with internal and external partners to effectively communicate findings and help to develop investigative strategies.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- 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 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
You may have worked in compliance already. But that's not like operating on a global scale. The stakes are high and the changes breathtaking. You will be challenged with thinking strategically as you implement effective compliance programs. You will be responsible for monitoring internal and external regulatory audits. And you will be expected to solve unique and complex problems with broad impact on the business.
- 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 investigations role
- Experience communicating complex information via phone conversations and emails to non-technical clients, external customers, internal customers and executives
- Experience interacting & collaborating with a variety of stakeholders (other team members, internal customers, and executives)
- Intermediate or better proficiency with MS Word, MS Outlook, MS Access
- Advance proficiency with MS Excel, SQL, VBA, Sampling Tools such as RAT STATS
- Experience working with Medicare, Medicare Advantage, Medicare Part D, Medicaid and/or Tricare regulations
- Master degree or Ph.D in Mathematics, Statistics and/or areas of related study
- Familiarity with data manipulation tools such as SAS and Tableau
As a Fortune 6 leader, UnitedHealth Group has created an environment that brings out the best in every single one of our 188,000 employees. And our mission couldn't be more critical. Take this opportunity to help millions live healthier lives and do your life's best work.(sm)
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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.
Job Keywords: LCRA, Medicare, Medicare Advantage, Medicare Part D, Medicaid and/or Tricare regulations, government, legal, health care, managed care and/or health insurance environment in a regulatory, privacy or compliance role, Minnetonka, MN Iselin, NJ, New Jersey, Telecommute