Investigations Consultant - Iselin, NJ

Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work.(sm) The Investigations Consultant will be responsible for triaging, investigating and resolving instances of healthcare fraud and / or abusive conduct by the medical profession, insured members or the broker community. This individual will be utilizing information from claims data analysis, plan members, employee's conduct confidential investigations and document relevant findings. They will report any illegal activities in accordance with all laws and regulations. The Consultant may also conduct onsite provider claim and / or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation. They will act as a subject matter with identifying, communicating and recovering losses as deemed appropriate. Where applicable, they will provide testimonials regarding the investigation. Primary Responsibilities: Triage, investigate and resolve instances of healthcare fraud and/or abusive conduct by the medical profession, insured members or the broker community Conduct data analysis and case generation activities Utilize information from claims data analysis, plan members, employees' conduct confidential investigations and document relevant findings Report any illegal activities in accordance with all laws and regulations Conduct onsite provider claim and / or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation Act as a subject matter with identifying, communicating and recovering losses as deemed appropriate Provide testimonials regarding the investigation Required Qualifications: Undergraduate degree in the area of Criminal Justice or related field or equivalent experience 5+ years experience with the group health business 5+ years experience within the insurance claims industry An intermediate level of proficiency in MS Excel, MS Word and MS Access An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to insurance Excellent verbal and written communication skills Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do 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. Job Keywords: Investigations Consultant, Investigation, Fraud, Iselin, NJ, New Jersey