Insight Analyst

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Insight Analyst is responsible for reviewing healthcare claims for possible fraud, waste and abuse. Actively works to identify and prevent payment of inappropriate or erroneous charges submitted by healthcare providers. Required to manage workload to ensure that cases are handled appropriately and resolved in a timely manner.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Properly manage daily workload to ensure that established task turn-around-times (TATs) are met

• Review Insight Summary Reports detailing case findings and recommendations to ensure accurate and timely delivery to clients

• Thoroughly review medical records/documentation and claim history to identify aberrant patterns or trends and exercise independent decision making to determine appropriate follow-up

• Review records to ensure they are relevant to the Date of Service and eligible for clinical/coding review

• Use the appropriate resources (state or board websites) to verify provider licensure and check for sanctions

• Work closely with the Insight Analyst Assistants to manage workload and provide direction

• Attend anti-fraud or healthcare related seminars, audio conferences and webinars throughout the year for the purposes of continuing education and training

• Acquire/maintain proficiency on all aspects of healthcare Fraud, Waste and Abuse

• Conduct research on providers using the internet, data analytics, and other resources for case development

• Recommend algorithms and edits for record review scenarios

• Identify and recommend positive enhancements to systems and processes

• Identify and request reports from the data analytics team

• Actively promote a team environment

• Exercise independent decision making

• Perform thorough documentation of all phone calls, conversations and actions taken on each medical record review

• Understand and adhere to HIPAA privacy requirements

• Provide professional and timely customer service to all assigned clients

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:

• High School Diploma/GED (or higher)
• 3+ years of experience in healthcare related or healthcare claims industry
• 2+ years of fraud, waste and abuse experience or healthcare claims processing experience may be substituted for each year of academic study
• 2+ years of experience with government healthcare programs preferred (Medicare, Medicaid)
• Intermediate level of proficiency in Microsoft Office applications

Preferred Qualifications:

• Healthcare fraud designation highly desirable. CFE or AHFI certifications preferred

• Strong communication and customer service skills

• Self-starter with superior oral and written communications skills

• Ability to work independently but also as a member of a team

• Strong time management, problem solving, organizational, and analytical skills required

• Must be detail oriented and possess the ability to multi-task

• All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii or Washington Residents Only: The salary range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island or Washington residents is $48,300 to $94,500 per year. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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

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.

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