Senior Fraud Investigator
for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Use - for any list of duties/requirements/benefits, and
for prose. Do NOT repeat job title as heading. Do NOT put Job ID/requisition numbers as headings. Remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning, duplicated lines, application instructions. Preserve all substantive info. Include a section only when posting has real specific content for it. Avoid filler like "commensurate with experience". Pay/Schedule/Benefits only if posting actually states them.
We need to parse the posting.
Content:
- Intro: "Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges."
- Then "Primary Responsibilities: (Percentage shows approximate portion of the working time spent on that responsibility)" then list with percentages.
- Then "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."
- Then "Required Qualifications" then list: High school diploma/GED, 2+ years of experience working with law enforcement or legal entities with fraud or healthcare investigations, Demonstrated intermediate proficiency in Microsoft Excel (pivot tables and macros) and Word (documents)
- Then "Preferred Qualifications" list: Healthcare fraud experience, Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar credentials, Familiar with CPT code terminology, Experience with computer research, Experience with data analysis and manipulating data for analysis, Experience in conducting interviews, Experience in investigating fraud in behavioral health, durable medical equipment, laboratory or interoperative neuromonitoring cases, Experience in conducting case presentations
- Then "All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy." (maybe part of benefits? but it's a policy, not benefit.)
- Then "Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives."
- Then "The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable."
- Then "Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records."
- Then "Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants."
- Then mission statements, EEO, drug-free workplace, etc. Those are boilerplate to remove.
We need to remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions.
Thus we should remove: Application Deadline line (application instructions). Also remove EEO statements, drug-free workplace, mission statements, etc. Also remove "All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy."? That is not boilerplate but a policy statement; maybe keep as part of responsibilities? It's a requirement for telecommuters. Could be part of "Requirements" or "Qualifications". Might be considered a requirement. But we can keep as a
under maybe "Requirements". However we need to decide sections.
We have content for:
- About the role: The introductory paragraph(s) describing Optum Insight, mission, flexibility to telecommute, etc. Could be "About the role". We'll put that as
About the role
with paragraphs.
- Responsibilities: The list with percentages. Use
- each item.
- Requirements: Could combine Required Qualifications and maybe the telecommuter policy? But we have "Required Qualifications" heading in original. We'll make
Required Qualifications
with - .
- Preferred Qualifications: Could be under "Preferred Qualifications" but we only have sections list: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. The instruction says use those headings if appropriate. It says "Use
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." So we can use "Qualifications" as a heading that encompasses both required and preferred? Or we could separate Required Qualifications and Preferred Qualifications under "Qualifications" with subheadings? But they said use those headings; they didn't forbid subheadings. However to keep simple, we could have "Qualifications" section containing both required and preferred as lists, maybe with
indicating required vs preferred. But better to follow the example: they gave "Requirements, Qualifications" as separate possible headings. So we can have both "Requirements" and "Qualifications". "Requirements" could be the required qualifications. "Qualifications" could be the preferred qualifications. Or we could invert. Let's decide: Use "Requirements" for required qualifications, and "Qualifications" for preferred qualifications. That seems logical.
- Skills: Not explicitly listed; we have some skill mentions in qualifications (Excel, Word, CPT, data analysis, interviewing, etc.) Those could go under Skills. But we already used them in qualifications. Might be redundant. The instruction: prefer a few substantive sections over many thin ones. So maybe combine qualifications and skills into one "Qualifications" section. But we have both required and preferred qualifications; we could put them under "Qualifications". Then we could have "Responsibilities", "About the role", "Pay", "Benefits". Schedule not mentioned (telecommute flexibility but not schedule). So we omit Schedule.
Pay: we have salary range and statement about pay based on factors. So we can have
Pay
with describing salary range and factors.
Benefits: we have comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution. Also mention telecommuter policy? Not a benefit. So we can have
Benefits
with - for each benefit.
We need to remove boilerplate: EEO, drug-free workplace, mission statements, application deadline, etc. Also remove duplicated lines (maybe none). Also remove "All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy."? That is not a benefit but a requirement for telecommuters; maybe we can include it under Requirements or Qualifications as a note. But it's a policy; could be considered a requirement. We'll include it as a
under Requirements (or Qualifications). However we already have Required Qualifications list; we could add a
after list: "All telecommuters must adhere to UnitedHealth Group's Telecommuter Policy."
Now we need to ensure we don't include filler like "commensurate with experience". Not present.
Now produce HTML fragment only.
Structure:
About the role
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Responsibilities
- Gather all relevant facts to drive investigations (30%)
- Utilize appropriate systems to monitor and document status of investigation (30%)
- Collaborate with clinical coding consultants and SMES to determine the validity of aberrances (10%)
- Collaborate with a variety of external sources to identify current and emerging patterns and schemes related for FWA to ensure additional TIP submission (5%)
- Perform member and provider interviews, and review medical documentation as needed (10%)
- Communicate clear rationale for investigation processes and outcome with legal, clients and stakeholders as needed (5%)
- Recommend next steps for each case (10%)
Requirements
- High school diploma/GED
- 2+ years of experience working with law enforcement or legal entities with fraud or healthcare investigations
- Demonstrated intermediate proficiency in Microsoft Excel (pivot tables and macros) and Word (documents)
All telecommuters must adhere to UnitedHealth Group's Telecommuter Policy.
Qualifications
- Healthcare fraud experience
- Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar credentials
- Familiar with CPT code terminology
- Experience with computer research
- Experience with data analysis and manipulating data for analysis
- Experience in conducting interviews
- Experience in investigating fraud in behavioral health, durable medical equipment, laboratory or interoperative neuromonitoring cases
- Experience in conducting case presentations
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
Pay
The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. We comply with all minimum wage laws as applicable.
We should also maybe include note about "In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)." Already captured in benefits list; we could add a about eligibility but not needed.
We removed application deadline, EEO, drug-free workplace, mission statements, etc.
Check for any duplicated lines: none.
Check for any boilerplate left: "All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy." we kept as a p under Requirements. That's fine.
Check for any mention of "Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records." That's EEO/legal boilerplate; should be removed. Yes remove.
Check for "We comply with all minimum wage laws as applicable." That's okay under Pay.
Check for "No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and
for prose. Do NOT repeat job title as heading. Do NOT put Job ID/requisition numbers as headings. Remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning, duplicated lines, application instructions. Preserve all substantive info. Include a section only when posting has real specific content for it. Avoid filler like "commensurate with experience". Pay/Schedule/Benefits only if posting actually states them. We need to parse the posting. Content: - Intro: "Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges." - Then "Primary Responsibilities: (Percentage shows approximate portion of the working time spent on that responsibility)" then list with percentages. - Then "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." - Then "Required Qualifications" then list: High school diploma/GED, 2+ years of experience working with law enforcement or legal entities with fraud or healthcare investigations, Demonstrated intermediate proficiency in Microsoft Excel (pivot tables and macros) and Word (documents) - Then "Preferred Qualifications" list: Healthcare fraud experience, Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar credentials, Familiar with CPT code terminology, Experience with computer research, Experience with data analysis and manipulating data for analysis, Experience in conducting interviews, Experience in investigating fraud in behavioral health, durable medical equipment, laboratory or interoperative neuromonitoring cases, Experience in conducting case presentations - Then "All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy." (maybe part of benefits? but it's a policy, not benefit.) - Then "Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives." - Then "The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable." - Then "Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records." - Then "Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants." - Then mission statements, EEO, drug-free workplace, etc. Those are boilerplate to remove. We need to remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. Thus we should remove: Application Deadline line (application instructions). Also remove EEO statements, drug-free workplace, mission statements, etc. Also remove "All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy."? That is not boilerplate but a policy statement; maybe keep as part of responsibilities? It's a requirement for telecommuters. Could be part of "Requirements" or "Qualifications". Might be considered a requirement. But we can keep as a
under maybe "Requirements". However we need to decide sections. We have content for: - About the role: The introductory paragraph(s) describing Optum Insight, mission, flexibility to telecommute, etc. Could be "About the role". We'll put that as
About the role
withparagraphs. - Responsibilities: The list with percentages. Use
- each item.
- Requirements: Could combine Required Qualifications and maybe the telecommuter policy? But we have "Required Qualifications" heading in original. We'll make
Required Qualifications
with- .
- Preferred Qualifications: Could be under "Preferred Qualifications" but we only have sections list: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. The instruction says use those headings if appropriate. It says "Use
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." So we can use "Qualifications" as a heading that encompasses both required and preferred? Or we could separate Required Qualifications and Preferred Qualifications under "Qualifications" with subheadings? But they said use those headings; they didn't forbid subheadings. However to keep simple, we could have "Qualifications" section containing both required and preferred as lists, maybe with
indicating required vs preferred. But better to follow the example: they gave "Requirements, Qualifications" as separate possible headings. So we can have both "Requirements" and "Qualifications". "Requirements" could be the required qualifications. "Qualifications" could be the preferred qualifications. Or we could invert. Let's decide: Use "Requirements" for required qualifications, and "Qualifications" for preferred qualifications. That seems logical. - Skills: Not explicitly listed; we have some skill mentions in qualifications (Excel, Word, CPT, data analysis, interviewing, etc.) Those could go under Skills. But we already used them in qualifications. Might be redundant. The instruction: prefer a few substantive sections over many thin ones. So maybe combine qualifications and skills into one "Qualifications" section. But we have both required and preferred qualifications; we could put them under "Qualifications". Then we could have "Responsibilities", "About the role", "Pay", "Benefits". Schedule not mentioned (telecommute flexibility but not schedule). So we omit Schedule. Pay: we have salary range and statement about pay based on factors. So we can have
Pay
withdescribing salary range and factors. Benefits: we have comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution. Also mention telecommuter policy? Not a benefit. So we can have
Benefits
with- for each benefit.
We need to remove boilerplate: EEO, drug-free workplace, mission statements, application deadline, etc. Also remove duplicated lines (maybe none). Also remove "All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy."? That is not a benefit but a requirement for telecommuters; maybe we can include it under Requirements or Qualifications as a note. But it's a policy; could be considered a requirement. We'll include it as a
under Requirements (or Qualifications). However we already have Required Qualifications list; we could add a
after list: "All telecommuters must adhere to UnitedHealth Group's Telecommuter Policy." Now we need to ensure we don't include filler like "commensurate with experience". Not present. Now produce HTML fragment only. Structure:
About the role
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Responsibilities
- Gather all relevant facts to drive investigations (30%)
- Utilize appropriate systems to monitor and document status of investigation (30%)
- Collaborate with clinical coding consultants and SMES to determine the validity of aberrances (10%)
- Collaborate with a variety of external sources to identify current and emerging patterns and schemes related for FWA to ensure additional TIP submission (5%)
- Perform member and provider interviews, and review medical documentation as needed (10%)
- Communicate clear rationale for investigation processes and outcome with legal, clients and stakeholders as needed (5%)
- Recommend next steps for each case (10%)
Requirements
- High school diploma/GED
- 2+ years of experience working with law enforcement or legal entities with fraud or healthcare investigations
- Demonstrated intermediate proficiency in Microsoft Excel (pivot tables and macros) and Word (documents)
All telecommuters must adhere to UnitedHealth Group's Telecommuter Policy.
Qualifications
- Healthcare fraud experience
- Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar credentials
- Familiar with CPT code terminology
- Experience with computer research
- Experience with data analysis and manipulating data for analysis
- Experience in conducting interviews
- Experience in investigating fraud in behavioral health, durable medical equipment, laboratory or interoperative neuromonitoring cases
- Experience in conducting case presentations
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
Pay
The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. We comply with all minimum wage laws as applicable.
We should also maybe include note about "In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)." Already captured in benefits list; we could add aabout eligibility but not needed. We removed application deadline, EEO, drug-free workplace, mission statements, etc. Check for any duplicated lines: none. Check for any boilerplate left: "All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy." we kept as a p under Requirements. That's fine. Check for any mention of "Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records." That's EEO/legal boilerplate; should be removed. Yes remove. Check for "We comply with all minimum wage laws as applicable." That's okay under Pay. Check for "No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and
- for each benefit.
We need to remove boilerplate: EEO, drug-free workplace, mission statements, application deadline, etc. Also remove duplicated lines (maybe none). Also remove "All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy."? That is not a benefit but a requirement for telecommuters; maybe we can include it under Requirements or Qualifications as a note. But it's a policy; could be considered a requirement. We'll include it as a
- .
- Preferred Qualifications: Could be under "Preferred Qualifications" but we only have sections list: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. The instruction says use those headings if appropriate. It says "Use