Healthcare FWA Investigator - Horsham (Philadelphia) PA

Do you have experience investigating Healthcare Fraud, Waste & Abuse (FWA)?  Want to work with an elite team of some of the brightest and most inventive people in the healthcare & technology industries?  UnitedHealthcare Medicare & Retirement, part of the UnitedHealth Group family of companies, dedicated to making the health system work better for everyone. We serve people throughout the entire health system. Our team enjoys conversation-changing, life-changing, world-changing opportunities throughout their careers. Join us and see what it's like to do your life's best work.(sm)
 
The Healthcare FWA Investigator will be responsible for triaging, investigating and resolving instances of healthcare fraud and / or abusive conduct by the medical profession, insured members or the broker community. This individual will be utilizing information from claims data analysis, plan members, and employee's to conduct confidential investigations and document relevant findings.  These cases can be very complex, and you will see an average of 5 to 10 new cases per week, and maintain a caseload of approximately 25-30 cases at any given time. You will conduct confidential post-pay investigations, document relevant findings, and report any illegal activities in accordance with all laws and regulations. They will act as a subject matter with identifying, communicating and recovering losses as deemed appropriate. When required, they will provide testimonials regarding the investigation.

Required Qualifications:

Associates Degree (or higher)
3+ years of experience working in a FWA or Fraud investigations role, preferably working on a Special Investigations Unit
Experience mining data from large data sets
Experience researching, compiling and reviewing data to develop error-free reports
Exceptional written, verbal, analytical, organizational, time management, and problem solving skills
An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to insurance
Strong interpersonal skills required; objective, collaborative approach
Ability to adapt in a dynamic and high-growth environment
Proven ability to work independently
Intermediate or better proficiency with MS Word & MS Excel
Preferred Qualifications:

Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar
MS  Access experience
Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)
 
 
Diversity creates a healthier atmosphere: 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. In addition, employees in certain positions are subject to random drug testing.
 
 
Job Keywords: fraud, waste, abuse, FWA, investigator, claims, health, healthcare, medical, insurance, Horsham, Philadelphia, PA, Pennsylvania