Clinical Fraud Analyst - RN, LPN, LCSW, LMSW, PT, OT
UnitedHealth Group 2,438 reviews - Atlanta, GA

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This position will serve our customers with clinical fraud detection advice and provide onsite software training for customers. The incumbent will develop and validate the final proofs used during User Acceptance Testing and conduct weekly internal training classes for staff analysts serving our customer accounts.

******* May offer a flexible schedule to accommodate commuting schedule and eligible to telecommute one day a week after a year of employment. ********

Responsibilities will include:
Organizes, sorts and filters data in order to distinguish patterns and recognize trends
Develops and maintains data preparation and validation routines to support data mining
Selects, recommends and applies appropriate analytic and statistical methodologies and techniques to execute against an analysis plan or research objectives
Serve as point of contact with our customers for questions and software issues
Prepare and conduct annual Users' Meeting for our customers
Provide clinical, fraud and business application guidance to development team
Publish customer newsletter of recent frauds (marketing service)
Create detailed clinical specification documents for our technical staff to build algorithms.

What makes your technology career greater with UnitedHealth Group? You'll have the most opportunities to grow and develop. We invest in rich technology resources and talented people to help glean and use intelligence in ways that drive quality and affordability of healthcare for millions of people worldwide. It's your chance to be a transformational force in the industry and within UnitedHealth Group. If you believe there is always a better way, take the next step in exploring your potential with UnitedHealth Group.

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Must have clinical license; RN, LPN, LCSW, LMSW, LPC, PT, OT or possess similar clinical degree
At least 4-5 years experience in healthcare fraud and abuse detection
Comfotable learning and using software
Intermediate to Advanced user of Word, Excel, and other software tools
Able to travel to customer sites10% of the time, and present and train groups of users clearly and articulately
In-depth knowledge of all types of health care claims (institutional, pharmacy, professional, dental, etc.)
Basic knowledge of statistics

Additional Preferred Assets:
Bachelors, BSN
Data processing development experience
Nursing or clinical background

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

RN, LPN, PT, OT, Clinical, Registered Nurse, Atlanta

About this company
2,438 reviews
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier...