Pharmacy Fraud Waste Abuse Analyst – Telecommute

UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life’s best work.(sm)

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

Primary Responsibilities:

• Investigates, reviews, and analyzes claims data applying knowledge of pharmacy policy and appropriate utilization patterns to provide recommendations for enrollment in pharmacy fraud waste and abuse programs
• Create/manage/maintain program-related documents and data (e.g., spreadsheets, reports, claims records, dashboard)
• Plans, prioritizes and organizes own work to meet established objectives and deadlines
• Ensures business processes are in place to monitor and manage operational processes as defined by the state contract and/or national standard
• Perform research to identify defects that lead to errors in program data
• Provides explanations and interpretations within area of expertise
• Investigates non-standard requests and problems, with some assistance from others and proactively identifies solutions
• Works with team to solve unique and complex problems
• Sometimes acts as a technical resource to others in own function

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 be interested in.

Required Qualifications:

• Previous experience in a pharmacy-related field
• Proficiency in software applications that include, but are not limited to: Microsoft Word, Microsoft Excel, Microsoft PowerPoint

Preferred Qualifications:

• Bachelor’s Degree
• Experience with pharmacy fraud waste and abuse
• Experience in Medicare or Medicaid Managed Care clinical programs
• Experience in health care and insurance industry, including regulatory and compliance requirements
• Analytics, database, project management experience

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement result in rescission of an employment offer or termination of employment.

Careers at UnitedHealthcare Medicare & Retirement . The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You’ll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It’s time to do your life’s best work.(sm)

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

Colorado, Connecticut or Nevada Residents Only : The salary range for Colorado residents is $45,100 to $80,200. The salary range for Connecticut/Nevada residents is $49,800 to $88,200. 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.

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.