Fraud Waste and Abuse System Analyst -Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

FADS (Fraud and Abuse Detection System) is a suite of complementary, web-based components that mine provider, member and claims data for potential fraud, waste and abuse; provide software research tools; and track subsequent investigation activity.  The FADS team is comprised of individuals with a variety of technical expertise from database, business intelligence reporting, and web based tools.  The FADS team is located in a North Atlanta suburb.

The FADS team is looking for a solid data-focused analyst able to quickly develop a comprehensive understanding of fraud, waste and abuse detection software. The analyst should have the ability to collaborate with multiple roles including fellow business analyst, data engineers, software engineers and report developers. This individual will be involved in many phases of an implementation project and/or an operational project and become familiar with the database structures, testing software, documentation procedure and training and User Manual formats. This role will be key in the successful implementation of new projects and the maintenance of existing projects.

Primary Responsibilities:

Support the full software development and implementation lifecycle
Analyze system requirements and technical specifications to create and execute test cases for individual application components
Analyze and interpret functional requests for their viability against the design of the system as well as business objectives to ensure the solution solves the business problem yet does not adversely impact the fundamentals of the system
Work independently, take initiative and handle multiple tasks simultaneously
Write test cases and execute testing within a web service environment
Write clear, concise, and extensive user documentation using advanced features of MS Word
Use advanced features of MS Excel such standard deviation, formulas and other functions
Plan, document, evaluate and track testing results to ensure system applications are free from defects
Establish and maintain test cases and test data, includes advanced knowledge of SQL
Actively participate in walk-through, inspection, and peer reviews  for quality assurance
Participate in production implementation verification and being accountable for validating system quality
Communicate and interact with appropriate areas on problems, changes and enhancements that may impact data, workflow and/or functionality within Information Technology software
Share knowledge (train) other team members and business users on any of the skills listed above
Identifying fraud, waste and abuse based on interpretation of policy, coding rules and data analysis

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.

Required Qualifications:

5 years business analysis experience
2 year data analysis experience, working with database structures
2 years of experience in healthcare Fraud, waste, and abuse identification
Intermediate SQL skills (native SQL)
Intermediate to advanced computer skills consisting of Microsoft Excel, Outlook, Word, and Power Point
Knowledge of healthcare claims, medical terminology, medical diagnostic, procedural terms

Preferred Qualifications:

Either a medical coding certification (AAPC, AHIMA or PMI) or AHFI certification from NHCAA
Knowledge of Medicaid policies and data (claims, provider & member)

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.







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.