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FWA Compliance Analyst - Telecommute Nationwide

Employer
UnitedHealth Group
Location
Eden Prairie
Salary
53300.00 - 95100.00 USD Annual

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Optum, a UnitedHealth Group company, is a dynamic health services and innovation company. As a global team of 125,000+, our skill and expertise is matched only by the commitment and passion we share to transform health care. We are tackling the biggest challenges in health care by partnering across the entire system. Together, we are transforming health care for a better future for everyone we serve. Our partners choose us for our combination of unique capabilities. This is a place like no other and where you'll do your life's best work.(sm)We are looking to fill a Government Case Affairs Compliance Analyst position on our Optum Operations team. This is a dynamic team, where you will be responsible for submitting referrals of suspected Fraud, Abuse, or Waste (FWA) according to state and federal regulations for all lines of business, including Medicaid, Medicare, and Commercial. You will work closely with our SIU Investigators, and you should have experience with UHG's FWA processes. Through preliminary notifications (prior to an investigation being started) and / or final notifications (after the investigation has been completed to substantiate any wrongdoing), you will be reporting and interfacing with Government Case Affairs customers, which include UHC M, UHC C, and UHC E and reporting on their behalf to regulatory agencies, including (but not limited to): Offices of Inspector Generals (OIG), Medic, Medicaid Fraud Control Units (MFCU), and Departments of Insurances (DOI) across the country. Government Case Affairs Compliance Analysts are aligned by regions (West, Central, and East) and are expected to be subject matter experts (SMEs) in their regions for all lines of business in that region. As a regional SME, the GCA Analyst is expected to understand the current regulatory requirements, contractual agreements, customer expectations, internal databases to access/validate supporting documentation, and turnaround times for their assigned region, for Commercial, Medicare, and Medicaid plans. GCA Analysts complete approximately 45 referrals a month. Each referral may include multiple lines of business, varying turnaround times, and regulatory requirements. Are you up for the challenge? You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Reporting fraud, waste, and abuse Referrals to State and Federal regulators Responding to inquiries pertaining to fraud, waste, and abuse from government entities, including regulators and law enforcement agencies You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: 1+ year of experience in Law Enforcement, Healthcare Regulations, and/or Healthcare Fraud Intermediate skills in Microsoft Office Suite and Adobe tools Project management skills (ability to work on multiple assignments / cases at the same time) Proficient in utilizing electronic databases If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders Preferred Qualifications: Bachelor's degree in Business, Criminal Justice or related field Demonstrated strong written and verbal communication skills Ability to work in a self-directed environment Legal, Medical Coding, or Compliance certifications Specialty Benefits (vision, hearing, dental, transportation) experience Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar Certified Coding Specialist Experience working in a matrix organization UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us. Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)Colorado Residents Only: The salary range for Colorado residents is $53,300 to $95,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter PolicyDiversity 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 employmentJob Keywords: Law Enforcement, Healthcare Regulations, Healthcare Fraud, Healthcare, Project Management, Electronic Databases, Telecommute, Compliance, Medical Coding, Legal, Specialty Benefits, Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator, telecommute, remote

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