Top 8 Remote investigations Jobs in Houston, Tx

Principal Investigator Pharmacy - Dallas and Houston, TX
UnitedHealthcare —Houston, TX
- $72,800 - $130,000 a year
- Full-time
- Remote
- Microsoft Word
- Up to 50% travel
- Pass drug screening
APS Investigator Specialist
Dept of Family & Protectve Svc —Houston, TX
- $3,581.33 - $5,372.41 a month
- Online Application
- Remote
- Background check
- Master of Social Work
- Clean driving record
- Paid holidays
- Dental insurance
Quick Apply
4d
EHS Compliance & Risk Advisor, Data Center Operations
Nscale —Houston, TX
- $80,000 - $140,000 a year
- Remote
- 5 years
- Bachelor's degree
- Continuous improvement
Quick Apply
Government Compliance Counsel
Accenture —Houston, TX
- $122,700 - $338,300 a year
- Full-time
- Remote
- 5 years
- Writing skills
- Analysis skills
- Paid holidays
- Disability insurance
10d
Senior Leader, U.S. Trade Compliance Program
ABB Inc. —Houston, TX
- $119,000 - $190,400 a year
- Full-time
- Remote
- Master's degree
- Bachelor's degree
- Continuous improvement
- Health savings account
- AD&D insurance
Quick Apply
Compliance Manager
Inframark —Houston, TX
- Full-time
- Remote
- Background check
- 7 years
- Up to 50% travel
- Paid holidays
- Health insurance
Quick Apply
7d

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remote investigations jobs near houston, tx

Principal Investigator Pharmacy - Dallas and Houston, TX

UnitedHealthcare -
Houston, TX

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Job Details

Full-time
$72,800 - $130,000 a year

Qualifications

Microsoft Word
Healthcare financial misconduct investigations
Investigations regulatory compliance
Medical law
Spreadsheets
Word embeddings
Driver's License
Healthcare billing investigations
Alternative dispute resolution
State and federal pharmacy laws
Associate's degree

Full Job Description

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 Principal Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste, and abuse. The Principal Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The Principal Investigator is responsible for conducting investigations which may include fieldwork to perform interviews and obtain records and/or other relevant documentation.

Travel: Up to 50% in the Dallas and Houston, TX areas. Applicants must be within commutable distance to Dallas and Houston, TX.

If you reside in Dallas, Houston, TX or surrounding area, you'll enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

Assess complaints of alleged misconduct received within the Company
Investigate 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 latter
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 workgroups or regulatory meetings
Communicate effectively, including written and verbal forms of communication
Develop goals and objectives, track progress and adapt to changing priorities

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

Associate's degree
3+ years of experience in fraud, waste and abuse (FWA) investigations/auditing
3+ years of experience with state/federal laws and regulations pertaining to healthcare FWA
3+ years of experience in analyzing data to identify fraud, waste and abuse trends
Ability to participate in legal proceedings, arbitration, and depositions in the direction of management
Demonstrate advanced level of proficiency in Microsoft Excel and Word
Demonstrate advanced level of knowledge in pharmacy claims processing
Reside within Dallas and Houston, TX or surrounding areas, with the ability to travel up to 50% in the Dallas and Houston, TX area
Access to reliable transportation and valid US driver's license

Preferred Qualifications:

Specialized knowledge/training in healthcare FWA investigations
Active affiliations with the National Health Care Anti-Fraud Association (NHCAA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)
License and/or Certified Pharmacy Technician (CPhT)
Operational experience with a pharmacy and/or pharmacy benefit manager (PBM)
All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #RED

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remote investigations jobs in houston, tx

Principal Investigator Pharmacy - Dallas and Houston, TX

APS Investigator Specialist

EHS Compliance & Risk Advisor, Data Center Operations

Government Compliance Counsel

Senior Leader, U.S. Trade Compliance Program

Compliance Manager

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