Optum, a UnitedHealth Group company, is a dynamic health services and innovation company. As a global team of 125,000+, our skill and expertise is matched only by the commitment and passion we share to transform health care. We are tackling the biggest challenges in health care by partnering across the entire system. Together, we are transforming health care for a better future for everyone we serve. Our partners choose us for our combination of unique capabilities. This is a place like no other and where you’ll do your life’s best work.(sm)
We are looking to fill a FWA Compliance and Regulatory Reporting Analyst position on our Optum Operations team. This is a dynamic team, where you will be responsible for compiling and submitting payment integrity reports the Compliance Regulatory Reporting Team compiles, either monthly, quarterly, semi-annually or annually based on the federal and state requirements. Business Requirements Documents (BRDs) are created and approved by all stakeholders and maintained by the Compliance Regulatory Reporting team. Are you up for the challenge?
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Monthly State Reports
- Bi-Monthly Compliance Committee Reports
- Quarterly State Reports: There are some health plans that are mandated by State statutes to provide quarterly reports that provide specific details, by provider, around the activities performed by the investigations unit. For additional details around Quarterly State Reports for a specific state, reference the appropriate BRD to this PNP.
- Annual State Reports: There are some health plans that are mandated by State and Federal statutes to provide annual reports that summarize the effectiveness of fraud plans and identify improvement opportunities. For additional details around Annual reports for a specific state, reference the appropriate BRD to this PNP.
- Maintains an accurate list of regulatory reports to be submitted for each Optum customer. The “Master Regulatory Reporting Calendar” was created to meet this responsibility.
- Research and analyze the federal and state regulations, as well as the applicable agency policies and contract standards as identified and supplied by Optum customers, so that the reports submitted satisfy the various and unique requirements.
- Submit these regulatory reports in a timely manner and meet the established deadlines.
- Consult with Optum Legal as to requirements that need interpretation.
- Work with Optum operational teams and, if needed, appropriate plan personnel, to abstract the necessary statistics and information to complete the regulatory reports.
- Follow the agreed upon process for obtaining customer approval prior to submitting the final report.
- Submit regulatory reports in the format requested by the regulating entities.
- Maintain a copy of all submitted regulatory reports along with the significant supporting information that was used to complete each report.
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.
- High School degree (Undergraduate degree preferred)
- 1+ year of experience in compiling and submitting regular reports (experience with FWA, Healthcare Regulations, and/or Healthcare Fraud is a plus)
- Intermediate skills in Microsoft Office Suite and Adobe tools
- Must be able to put together and work with Pivot Tables in MS Excel
- Project management skills (ability to work on multiple assignments / reports at the same time)
- Must have keen attention to detail and ability to meet deadlines for filing various reports
- Demonstrated strong written and verbal communication skills
- Ability to work in a self-directed environment
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- Bachelor’s degree
- Experience working in a matrix organization
As a Fortune 6 company with over 325,000 people all pulling in the same direction, we’re used to setting the pace for change. Take a running start and join us so you can achieve more while doing your life’s best work.(sm)
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Colorado Residents Only: The salary range for Colorado residents is $53,300 to $95,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
Key words: FWA, fraud, waste, abuse, investigator, investigation, legal, law, enforcement, police, healthcare, claims, reporting