THIS ROLE IS TEMPORARILY REMOTE. TRAINING IS CONDUCTED VIRTUALLY FROM YOUR HOME. THIS ROLE IS AN ONSITE ROLE AND ONCE TRAINING IS COMPLETED, YOU WILL TRANSITION TO WORK IN THE OFFICE IN THE FUTURE.

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing YOUR LIFE’S BEST WORK.SM

Flexible, Friendly, Fast on your feet, that's a great start. Accurate, Accountable, Self-Directed; These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and they way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment. SENIOR CLAIMS BUSINESS PROCESS ANALYSTS are responsible for all related aspects of claim system processes and claim business rules. Include claims systems utilization, capacity analyses/planning and reporting, claims-related business and systems analysis. Ensure data integrity, data security and process optimization.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (7:30am - 4:00pm pacific time) It may be necessary, given the business need, to work occasional overtime. Our office is located at 2720 N Tenaya Way Las Vegas NV 89120.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

PRIMARY RESPONSIBILITIES:

• Responsible for triaging, investigating and educating instances of healthcare fraud waste and or abuse by the medical profession or insured members.
• Develop and deploy the most effective and efficient investigative strategy for each investigation
• Review claims data and conduct analysis to look for patterns for potential fraud waste and/or abuse
• Maintain accurate, current and thorough case information in the Fraud Database.
• Collect and secure documentation or evidence and prepare summaries of the findings.
• Conduct investigations to review claims history and compare medical documentation against procedural codes billed.
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Report suspected fraud waste and abuse to appropriate federal or state government regulators

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:

• Bachelor’s Degree (or higher) or equivalent experience.
• 2+ years experience in claims processing, healthcare provider information and/or healthcare billing practices.
• Working knowledge of medical terminology
• Intermediate level of experience in Microsoft Excel and Word for reporting, manipulating data and creating pivot tables
• 3+ years in a technical or metrics-based environment; preferably claims and/or customer service 
• Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new complex computer system applications
• Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance. Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.

TELECOMMUTING REQUIREMENTS:

• Reside within 120 miles of Las Vegas, NV with the ability to attend the onsite upon notice at our Las Vegas office
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

PREFERRED QUALIFICATIONS:

• Specialized knowledge/training in healthcare FWA investigations
• National Healthcare Anti- Fraud association (NHCAA
• Accredited Healthcare Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• Certified Professional Coder (CPC)
• Working knowledge of claim coding
• Intermediate level of knowledge with local, state/federal laws and regulations pertaining to healthcare fraud, waste and abuse.

SOFT SKILLS:

• Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product

UNITEDHEALTH GROUP REQUIRES ALL NEW HIRES AND EMPLOYEES TO REPORT THEIR COVID-19 VACCINATION STATUS.

MILITARY & VETERANS FIND YOUR NEXT MISSION: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

CAREERS AT UNITEDHEALTHCARE EMPLOYER & INDIVIDUAL. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is YOUR LIFE'S BEST WORK.SM

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.

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