Audit Representative Senior

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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

Positions in this function are responsible for all aspects of quality assurance within the Customer Service job family. Conducts audits and provides feedback to reduce errors and improve processes and performance.

Generally audits are conducted of production staff equal to or lesser than the salary grade level so indicated.

Primary Responsibilities:

• Performs routine or structured work
• Responds to routine or standard requests
• Uses existing procedures and facts to solve routine problems or conduct routine analyses
• Perform Quality audits and analyze results to determine process improvement opportunities
• Develops and delivers fact-based audit determinations in an objective, non-confrontational manner
• Ensure that customer needs are being met by current processes (e.g., review recorded agent conversations, identify/communicate opportunities for improvement)
• Ensure appropriate usage of available resources by agents to respond to callers (e.g., applicable scripts, Subject Matter Experts)
• Maintains reporting infrastructure, as appropriate (e.g., SharePoint, Access databases, Excel spreadsheet)
• Escalates issues identified during the audit cycle or rebuttal process to applicable stakeholders, as appropriate (e.g., Subject Matter Experts, Operations Team, Quality Team, business partners, team leads)
• Ensures compliance with applicable audit and rebuttal timelines (e.g., calibration timelines, rebuttal timelines/form completion, workflows, turnaround time)
• Achieves production quality goals/metrics (e.g., audits per hour, audit accuracy, first-pass accuracy, rebuttal accuracy)
• Provides supporting documentation for audit findings
• Manages audit inventory to ensure proper workload balance, coverage and closure
• Identify/communicates escalated errors/defects and ensure proper resolution, as needed (e.g., calibrations, rebuttals, appeals)
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• 1+ years prior experience in a transactions based operation
• 1+ years of experience within a matrix organization, healthcare or insurance company
• Knowledge/experience with account based products
• Basic knowledge of theories, practices and procedures related to Customer Service
• Working knowledge of 1-2 Lines of business within the UHC structure-(Medicare & Retirement, Community & State, and Employer & Individual)
• Working knowledge of applicable platforms across the 1-2 lines of business (ex: UNET, COSMOS, COMET, CPS, Or Facets)
• High level knowledge of quality process/approach (BPQM or Six Sigma lean principals)
• Beginner to Intermediate MS Office skills including MS Word, MS Excel, and demonstrated ability to understand  basic excel data structure
• Interpersonal Skills – Proven ability to deal and work with people with different backgrounds
• Decision-Making Skills – Proven capable of arriving at the appropriate decisions after weighing the pros and cons of all the options in consultation with department managers/SME’s
• Communication Skills – Proven excellent verbal and written communication skills in addition be a good listener to give value to the opinion and suggestion of others
• Accountability – Takes ownership of tasks, performance standard and quality results.  Maintains necessary attention to detail to achieve high level performance
• Problem Solving – Proven solution Driven Approach Skills – demonstrate ability to review problem, troubleshoot root cause issues and determine path to resolution with appropriate guidance
• Flexible – Proven ability to work effectively in a changing environment and contribute innovative ideas
• Accuracy and Efficiency – Proven excellent time management and organizational skills balancing multiple priorities. Accurate when processing detailed tasks while meeting deadlines
• Proven self-starter, able to independently, drive work and prioritize work with moderate oversight
• Function in a Subject Matter Expert (SME) capacity within a team of peers at or below existing job code/level structure

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.