SIU Investigative Assistant
7 days left
- Employment Status
- Full Time
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. SIU INVESTIGATIVE ASSISTANTThis position is responsible to capture and perform detailed analysis of Special Investigations Unit (SIU) Fraud case leads. Resolve case leads timely utilizing investigative techniques, including health care claims review, to obtain sufficient information in support of conclusions. Document results of all leads and resolutions. For complex cases, perform case set up and preparation activities for the team. Perform small investigations and ·Retrieve and receive SIU leads made via the intranet, Compliance Hotline, Compliance email box, and other methods for reporting SIU leads (allegations). Accurately document allegations and set up incidents in the compliance tracking software. ·Utilize investigative techniques to gather pertinent facts and allegations as well as background information and payment amounts. Return phone calls, answer telephone inquiries, and request records or other necessary information. Review information collected and document results and conclusions to determine validity or impact of case lead. Exercise initiative and sound judgment in responding to reported SIU leads in accordance with established policies and procedures. ·Manage and execute SIU data tracking and reporting responsibilities. Accurately compile and complete reports, statistical data, charts, graphs and tables. Aggregate and format reports as needed, for both internal distribution and to fulfill external regulatory requirements with DHS and CMS. ·Compose correspondence, documents and reports, as needed. Create and edit spreadsheets including formulas and trending/analytics. ·Intake data requests and regulatory inquiries, coordinating or assisting with responses as directed. ·Perform investigations on small cases, as assigned. Document case files, conclusions and investigative reports. ·Provide investigative assistance to SIU staff on complex cases, as needed. ·Other projects and duties as assigned. Assist in larger investigations, as necessary.
EducationTwo-year degree required. Bachelor's degree, paralegal certificate or other post-secondary education preferred.
Required ExperienceProficient PC skills, preferably Microsoft Office with basic spreadsheet or database competencies, experience using a claims-based system for look-up of claims/provider/member information, preferably experience with health care claims; experience writing reports, business letters, and/or other business materials; health care experience with knowledge of Medicaid and Medicare, preferably experience working for a managed care company.
Preferred ExperienceUnderstanding of medical terminology. Understanding of pharmaceuticals. Legal or investigative background a plus. THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 9th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.