Information for Memo

UnitedHealth Group is a health insurance company that is organized in order to make a profit. They are headquartered in Minnesota. They are the largest health insurance company in the United States. They also have room to grow as they haven’t tapped the foreign market yet. The department my father worked in was fraud and abuse. That is just one aspect of the company as there is of course those who sell the plans, review applicants and plans, monitor spending, marketing, etc. All the aspects a business needs to function.

IS Consultant: audited claims and recovered money. Fraud to misbilling. Basically reviewing claims to get money. Some are honest reasons, some are not. Billions of dollars that are gone back after. Recovered billions each year. All types, physician to hospital, to personal. There are time limits, so some take more precedence than others for recovery and prosecution. Not just hospital and physician, members of the insurance also are dishonest. Hospitals will even give false diagnosis to insurance to get more money. It is basically a fight between people trying to get the money and United Health Group trying to keep the money.

Day in the life. Talk to the customer to find out the result wanted. Find the data and parameters required to write the code to find the data to recover the funds. Then do the process and write the code, then submit it to the client in an access file or .xml or excel. Then write a report to them to explain the process and the results. All is on the consultant though, it is your job to find what the customer is looking for or you are wrong. You have to know the business or you are no use to the customer. This leaves it in writing and makes it official so the money can be reacquired and if necessary further action against a wrongful entity. It is all on the consultant to make sure the end product is sufficient because the bottom line is making money back.

Had to thoroughly make sure the explanations were understood. When programs are run, they must be analytically correct, or the information is meaningless. The main programs are called SAS and Sequel. They are a fourth generation language that uses the english language to code. You still have to be trained, but you essentially write what you want the program to find or sort by and then you analyze the result.

You have to be of use to the customer and the company. You must go beyond their expectations and exceed the basic requirement. You have to look at the project as a whole to give all the information to help them do their job easier. They don’t have the tools or computers, or the knowledge on how to understand it in order to make a recovery. It is up to you to analyze the data and decide if it applies to a small number of claims or millions of claims. If it is found that the insurance company was wronged, the fraudulent entity that tried to cheat the insurance company will have the money taken from them and then persecuted based on the data and reports written by the consultant. It is common for doctors to even double and triple bill in order to get more money than the services provided. The doctors see the insurance company as the crook and the insurance company sees the doctors and others as the crooks. It is a flawed system, but it is the system in place.

A common analysis is doctors with high dollar accounts. It is necessary to see why a doctor’s balance for services is high. Lower balance accounts are also looked at as many smaller fraudulent billings add up. There is also the problem of UnitedHealth Group not being the proper entity to be paying the claim. It could be another health account or medicare, then the doctor or insurance member trying to double bill and collect the money twice.

Thoughts and ideas for PowerPoint for background of recorded webinar.

The movie Wall Street is about how greed is a fuel for the economy.

Watching the movie and looking at the at co market at it’s release and the current economic climate could be good research for analysis. Doing an analysis could help to better understand how the market works and how some people do business. It can also teach someone how to operate and make money in a capitalist economy.

This is an example post, originally published as part of Blogging University. Enroll in one of our ten programs, and start your blog right.

You’re going to publish a post today. Don’t worry about how your blog looks. Don’t worry if you haven’t given it a name yet, or you’re feeling overwhelmed. Just click the “New Post” button, and tell us why you’re here.

Why do this?

• Because it gives new readers context. What are you about? Why should they read your blog?
• Because it will help you focus you own ideas about your blog and what you’d like to do with it.

The post can be short or long, a personal intro to your life or a bloggy mission statement, a manifesto for the future or a simple outline of your the types of things you hope to publish.

To help you get started, here are a few questions:

• Why are you blogging publicly, rather than keeping a personal journal?
• What topics do you think you’ll write about?
• Who would you love to connect with via your blog?
• If you blog successfully throughout the next year, what would you hope to have accomplished?

You’re not locked into any of this; one of the wonderful things about blogs is how they constantly evolve as we learn, grow, and interact with one another — but it’s good to know where and why you started, and articulating your goals may just give you a few other post ideas.

Can’t think how to get started? Just write the first thing that pops into your head. Anne Lamott, author of a book on writing we love, says that you need to give yourself permission to write a “crappy first draft”. Anne makes a great point — just start writing, and worry about editing it later.

When you’re ready to publish, give your post three to five tags that describe your blog’s focus — writing, photography, fiction, parenting, food, cars, movies, sports, whatever. These tags will help others who care about your topics find you in the Reader. Make sure one of the tags is “zerotohero,” so other new bloggers can find you, too.