UnitedHealthcare is looking to investigate potential fraud, waste, and abuse within healthcare claims by monitoring data patterns, conducting detailed analyses, and generating reports to aid in compliance efforts.
Requirements
- Minimum of 2 years of experience supporting healthcare claims data analysis or related projects
- At least 1 year of experience with VBA (Visual Basic for Applications)
- At least 1 year of experience with SAS and/or SAS Enterprise Guide (EG)
- Proficiency in creating and utilizing data modeling tools, spreadsheets, and data acquisition tools
- Advanced proficiency in MS Excel, including formulas, pivot tables, macros, and statistical functions
- Intermediate proficiency in MS Office Suite (Word, PowerPoint, Outlook)
- SQL experience for data querying and management
Responsibilities
- Perform comprehensive data analysis and generate reports for the investigations team, including data extracts, summaries, sampling, and special projects
- Prepare healthcare claims data for investigative purposes and collaborate with investigation teams to interpret data content
- Support data collection activities for the Special Investigations Unit (SIU) and generate routine regulatory and executive reports
- Create and distribute scheduled and ad-hoc reports related to product development, operational performance, and technological insights
- Analyze data to identify trends, patterns, and opportunities for process improvement and business growth
- Communicate findings clearly to technical teams, management, and external stakeholders, ensuring understanding of complex data insights
- Maintain data integrity and security while supporting compliance initiatives and investigations
Other
- Experience communicating complex data insights to non-technical audiences via phone and email
- Ability to work independently and research regulations effectively
- Bachelor's Degree in Data Science, Statistics, Healthcare Administration, or a related field
- Industry certifications such as Certified Fraud Examiner (CFE), Associate of Healthcare Fraud Investigators (AHFI), or Certified Professional Coder (CPC)
- Experience working in government, legal, healthcare, managed care, or health insurance environments with a focus on regulatory, privacy, or compliance roles
