Role Description Employees are responsible for triaging, investigating, and resolving potential instances of healthcare fraud and/or abusive conduct by medical professionals or providers. Using information from tips, complaints, external intelligence or behavior data, the medical community and law enforcement, employees conduct confidential investigations and document relevant findings and report any illegal activities in accordance with all laws and regulations. Identify, communicate, and recover losses as deemed appropriate. These investigations may include participation in telephone calls or meetings with providers, members, clients, legal compliance, and other investigative areas and requires adherence to state and federal compliance policies, reimbursement policies, and contract compliance. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Gather and analyze data and information gathered to determine behavior and understand provider/scheme at issue - Utilize appropriate documentation and tracking controls in the case tracking system to ensure compliance and auditability requirements are met - Collaborate with SIU Lead Investigator to apply knowledge of coding guidelines to determine validity of aberrances - Collaborate with a variety of external sources to identify current and emerging patterns and schemes related to FWA - Perform member and provider interviews, and review medical documentation as needed - Communicate with legal, Law Enforcement, clients and business partners as needed - Perform all other duties as assigned Qualifications - High School Diploma/GED - 5+ years of experience working in a FWA / SIU or Fraud investigations role - Certified Professional Coder (CPC, CCS, CPMA) or RHIT - 2+ years of experience within the health insurance claims industry - 1+ years of knowledge and/or experience with medical/behavioral health codes and service delivery - Intermediate level of proficiency in Microsoft Excel (pivot tables and macros) and Word (creating, editing, and saving documents) Requirements - Associate’s degree in Criminal Justice or experience in a related field (preferred) - 2+ years of experience working with law enforcement or legal entities or 3+ years of investigative experience with fraud investigations (preferred) - Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar (preferred) - Familiar with CPT code terminology (preferred) - Experience with computer research (preferred) - Experience with regulatory compliance (preferred) - Experience with data analysis as it relates to financial recovery/settlements (preferred) Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) Company Description 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Role Description As a Revenue Cycle Performance Analyst, you will be joining a dedicated team of professionals who deliver quality, value, and access in the 21st century and align all stakeholders—patients, providers, payors, and regulators—to achieve the best clinical outcomes. - Interpret basic revenue cycle and financial data. - Maintain databases and templates ensuring data integrity through monitoring and auditing outputs. - Collect and assist in the analysis of qualitative/quantitative data reports extracted from various systems. - Incorporate results of statistical and qualitative analyses utilizing Microsoft Excel, Word, Access, and PowerPoint. - Proactively analyze data to identify and resolve potential issues that could have an adverse effect on revenue cycle performance. - Apply concepts and tools of health care economics to enhance understanding of utilization, quality, and performance patterns across health care networks. - Collaborate with management staff to provide rigorous analysis in support of RadNet revenue cycle operational objectives. - Prepare reports to evaluate and interpret data to monitor performance, identify trends, and determine root causes of issues. - Develop financial and statistical reporting to use in analysis, tracking, and trending of revenue cycle operation activities. Qualifications - Bachelor's degree in Accounting, Business, Finance, Healthcare Administration, Computer Science, or an equivalent combination of education and work-related experience. - Effective at working both at a detailed data level and a strategic thinking level. - Minimum 3 years’ experience with medical claim business system software. - Minimum 3 years Health insurer industry experience, with business knowledge of benefits, claim systems, and adjudication principles. - Minimum 3 years of medical and/or benefit policies, provider contract and/or employer plan designs, professional and facility claim processing, and medical terminology and industry standard code sets (CPT-4, ICD-9-CM, ICD-10, etc.). - Minimum 3 years’ experience managing multiple assignments, independently determining solutions, and anticipating/preventing potential problems. - Minimum 3 years’ experience in Microsoft Excel, and extensive use of data query logic. - Expertise needed in EDI transaction exposure such as 270, 271 for healthcare benefits and eligibility, 276, 277 for claims status, 278 for transmitting health care service information, 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products. Requirements - Communicates, cooperates, and consistently functions professionally and harmoniously with all levels of supervision, co-workers, patients, visitors, and vendors. - Demonstrates initiative, personal awareness, professionalism, integrity, and exercises confidentiality in all areas of performance. - Follows all local, state, and federal laws concerning employment to include but not limited to: I-9, Harassment, EEOC, Civil rights, and ADA. - Follows OSHA regulations, RadNet, and site protocols, policies, and procedures. Benefits - Pay Range: $60,000-$70,000 per year

Role Description Provides support in conducting research, analysis, and reporting across healthcare and operational data to support decision‑making, cost‑containment strategies, and business performance improvement. Works with complex datasets including claims, pharmacy, lab, and operational data to design, develop, validate, and maintain reports, dashboards, and analytical tools. Partners with internal teams to gather requirements, enhance reporting processes, and ensure data accuracy, consistency, and usability. - Analyzes healthcare and operational datasets to identify trends, anomalies, and opportunities for improvement. - Develops, validates, and maintains recurring and ad hoc reports using Structured Query Language (SQL), Excel, Business Intelligence (BI) tools, and other analytics platforms. - Organizes, documents, and maintains datasets and reporting workflows across multiple business areas. - Creates dashboards, queries, and reporting solutions that support utilization analysis, cost containment, and operational performance. - Consolidates research and analysis into clear summaries and recommendations for business stakeholders. - Supports regulatory, contractual, and enterprise reporting requirements, including state mandated submissions. - Identifies and implements enhancements or fixes to existing reports and reporting processes. - Collaborates with cross functional teams to define reporting requirements and maintain project/report timelines. - Assists with special projects and data requests from internal departments and external agencies. Qualifications - At least 2 years of experience in data analysis, reporting, or healthcare analytics, or equivalent combination of relevant education and experience. - Analytical Problem Solving: Ability to interpret complex datasets, identify patterns, and translate findings into actionable insights. - Technical Proficiency: Comfortable working with SQL, Excel, and reporting/analytics tools; able to learn new technologies quickly. - Attention to Detail: Ensures accuracy in data validation, report development, and documentation. - Collaboration & Communication: Works effectively with cross functional teams to clarify requirements and present findings. Requirements - Experience with SQL Server Reporting Services (SSRS), Crystal Reports, MedInsight, or similar tools. - Knowledge of healthcare utilization metrics, medical cost analysis, and performance indicators. - Familiarity with predictive modeling concepts and trend forecasting. - Microsoft certification or similar technical credentials. Benefits - Molina Healthcare offers a competitive benefits and compensation package. - Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description We are seeking a Quality Assurance Analyst to support a large-scale document scanning and digitization project. This role is responsible for ensuring that all scanned documents meet accuracy, completeness, and quality standards before being uploaded into the client’s system. Training will be provided by the client. - Review scanned documents to verify clarity, accuracy, and completeness. - Perform quality checks to ensure correct indexing and categorization of files. - Identify and report errors, inconsistencies, or missing information. - Document quality issues and work with the project team to resolve them. - Ensure compliance with project guidelines and client requirements. - Maintain logs of quality control checks and audit results. - Provide feedback to scanning operators to improve accuracy and efficiency. Qualifications - Strong attention to detail and organizational skills. - Basic computer proficiency (MS Office, document management systems). - Ability to follow detailed processes and guidelines. - Strong communication and problem-solving skills. - Excellent verbal and written English communication skills and the ability to interact professionally with a diverse group are required. Requirements - The expected base salary for this position is up to $25.00/hour. - Salary offers are based on a wide range of factors including relevant skills, training, experience, education, market factors, and where applicable, licensure or certifications obtained. - In addition to salary, a competitive benefit package is also offered. Company Description CTG, a Cegeka company, delivers IT and business solutions that enhance clients’ digital agility, empowering them to seize new opportunities and overcome any challenge. Backed by more than 60 years’ experience and a commitment to being a reliable, results-driven partner, we work shoulder to shoulder with clients to shape digital together. - Our vision is to be an indispensable partner to our clients and the preferred career destination for digital and technology experts. - With more than 9,000 team members in over 15 countries, we combine global expertise with local insight to deliver innovative solutions. - We operate across the Americas, Europe, and India, working with over 3,000 clients in many of today's highest-growth industries. - CTG is fully committed to promoting employment opportunities for members of protected classes.