Fraud & Abuse Investigator - Healthcare Fraud Investigation

AmeriChoice, a UnitedHealth Group company, is a recognized leader and innovator in providing managed health care solutions to its Medicaid membership.  With over a decade of growth and success we are poised for continued expansion of our services in this dynamic marketplace. Our commitment to this specialized market makes a genuine difference in thousands of lives. Join us, do rewarding work, and build a great career.

 

We’re looking for a confident, assertive individual to conduct healthcare fraud investigations for AmeriChoice health plans in New Jersey, New York and Pennsylvania. Enjoy a high degree of autonomy in this key role with our Special Investigations Unit.

 

Primary responsibilities include:

 

-  Conducting complex healthcare fraud and abuse investigations

-  Analyzing claim data using fraud detection software

-  Interviewing providers and members regarding services received

-  Consulting with subject matter and clinical experts

-  Preparing comprehensive written investigation reports

-  Making referrals to regulatory and law enforcement agencies

-  Conducting settlement negotiations





Law enforcement experience is strongly desired, as well as experience conducting insurance or healthcare fraud investigations. Familiarity with CPT and ICD-9 coding is preferred. Bachelor's degree is also preferred.

 

UnitedHealth Group offers a full range of comprehensive benefits, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan. Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V.