Top 82 Complaints investigator Jobs in Remote

Investigator
UnitedHealthcare —Houston, TX
- $49,700 - $88,800 a year
- Full-time
- Remote
- Microsoft Word
- Pass drug screening
- Mid-level
4d
Senior Investigator
UnitedHealthcare —East Brunswick, NJ
- $60,200 - $107,400 a year
- Full-time
- Remote
- Microsoft Word
- Pass drug screening
- Driver's License
- AD&D insurance
- Employee stock purchase plan
1d
Employee Relations Investigator
Radial, Inc. —Remote
- $94,100 - $159,900 a year
- Online Application
- Remote
- 7 years
- Analysis skills
- Continuous improvement
- Health savings account
- Disability insurance
Employee Relations Generalist-West Coast
Michael Kors —Remote
- $80,000 - $92,000 a year
- Full-time
- Mid-level
- Bachelor's degree
- Organizational skills
- Wellness program
- Commuter assistance
Case Reviewer
Constellis —Remote
- Extended hours
- 18 years or older
- Microsoft Excel
- 5 years
Customer Service Representative
Sagility —Remote
- Remote
- Research
- Mid-level
Senior Investigator Employee Relations
Dycom Industries, Inc. —Remote
- 18 years or older
- Google Workspace
- 7 years
- Employee stock purchase plan
- Paid holidays
Quick Apply
Senior Investigator
USC —Los Angeles, CA
- $98,776 - $139,000 a year
- Remote
- Master's degree
- Presentation skills
- Conflict management
Audit/Investigation Coordinator II
Qlarant —Remote
- $43,680 - $47,840 a year
- Full-time
- Remote
- Mid-level
- High school diploma or GED
Quick Apply
6d
Certified EEO Investigator
CES, LLC —Remote
- 8 hour shift
- Remote
- Microsoft Excel
- Writing skills
- Mid-level
Quick Apply
Case Manager
Constellis —Remote
- Extended hours
- 18 years or older
- Microsoft Excel
- 5 years
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
Legal Assistant
Contact Government Services, LLC —Remote
- $45,000 - $55,000 a year
- Full-time
- Hybrid work
- Microsoft Access
- Microsoft Outlook
- Research
- Health insurance
- Dental insurance
Quick Apply
Senior Investigator Pharmacy - Los Angeles County, CA
UnitedHealthcare —Los Angeles, CA
- $60,200 - $107,400 a year
- Full-time
- Remote
- Microsoft Word
- Up to 50% travel
- Pass drug screening
- AD&D insurance
- Employee stock purchase plan
Paralegal
Aleknagik Technology —Washington, DC
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Mid-level
Quick Apply
10d
Senior Human Resources Consultant
SEDAA —Oakland, CA
- $40 - $47 an hour
- Remote
- Research
- Mid-level
- Residential
Quick Apply
4d
Deputy Title IX Coordinator for Investigations
Liberty University —Remote
- $80,000 - $110,000 a year
- Full-time
- Clean driving record
- Microsoft Outlook
- 5 years
- Health insurance
- Tuition reimbursement
5d
eLearning Developer
VERSA Integrated Solutions —Washington, DC
- $75,000 - $100,000 a year
- Full-time
- Remote
- Computer Science
- 5 years
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Virtual Assist Auto Adjuster - Mountain or Pacific Time Zone - Remote
Allstate —Remote
- $65,600 - $111,550 a year
- Full-time
- Background check
- Computer literacy
- Mid-level
- Wellness program
- Paid parental leave
Senior Manager, Global Clinical Development (GCD) - Metabolic Dietitian
Otsuka —Remote
- $150,034 - $224,250 a year
- Full-time
- Remote
- 5 years
- Senior level
- AD&D insurance
- Paid holidays

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complaints investigator jobs near remote

Investigator

UnitedHealthcare -
Houston, TX

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Job Details

Full-time
$49,700 - $88,800 a year
4 days ago

Qualifications

Microsoft Word
Healthcare financial misconduct investigations
Investigations regulatory compliance
Medical law
Spreadsheets
State healthcare regulations
Investigative data analysis
Healthcare billing investigations
Investigating compliance violations
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 Investigator is responsible for identification, investigation and prevention of healthcare fraud, waste, and abuse. The Investigator will utilize claims data, applicable guidelines, and other sources of information to identify aberrant billing practices and patterns. The 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 work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities :

Assess complaints of alleged misconduct received within the Company
Investigate low to medium 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
Must participate in legal proceedings, arbitration, and depositions at the direction of management

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
1+ years of experience in health care fraud, waste and abuse (FWA) investigations/audit
Basic level of knowledge/training in healthcare FWA investigations
Basic level of knowledge with state/federal laws and regulations pertaining to healthcare FWA
Basic level of knowledge in analyzing data to identify fraud, waste and abuse trends
Intermediate level of proficiency in Microsoft Excel and Word
Ability to travel up to 25%

Preferred Qualifications:

Active affiliations with the National Health Care Anti-Fraud Association (NHCAA)
Accredited Health Care Fraud Investigator (AHFI)
Certified Fraud Examiner (CFE)
Certified Professional Coder (CPC)
Certified Pharmacy Technician (CPhT)
Medical Laboratory Technician (MLT)
Statistical Analysis
All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

For more information on our Internal Job Posting Policy, click here.

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 $49,700 to $88,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

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, #GREEN

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Refine Your Search

complaints investigator jobs in remote

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