Claims Quality and Audit Representative – Remote in Multiple Locations

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. 

The Claims Quality and Audit Representative primary responsibilities are to conduct reviews during the Itemized Bill Review active claim process and provide feedback to reduce errors and improve processes and performance.

This position is full-time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:30 am – 3:30 pm MST. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of training during normal business hours.

If you are located in Mountain, Pacific, or Central Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.

  

Primary Responsibilities:

• Validate / analyze claim data for accuracy utilizing job aids, claim documents, policies, and procedures
• Deliver / communicate fact-based quality review determinations in objective, non-confrontational manner 
• Provide supporting documentation for audit findings
• Maintain tracking/reporting of daily tasks
• Achieve production and quality goals/metrics
• Identify / communicate uncommon patterns / trends to Team Lead / Manager
• Demonstrate working knowledge of product, process, systems and applications 

  

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:

• High School Diploma / GED
• Must be 18 years of age OR older
• 3+ years of professional work experience / knowledge of the healthcare industry
• 1+ year of telecommuter experience
• Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
• Experience with Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management)
• Ability to work between the hours of 6:30 am – 3:30 pm MST from Monday – Friday including the flexibility to work occasional overtime based on business need

  

Preferred Qualifications:

• 3+ year of medical claims and / OR auditing experience
• Knowledge of insurance and / OR medical terminology
• Product / process knowledge
• System / application knowledge

  

Telecommuting Requirements: 

• Reside within Mountain, Pacific, or Central Time Zone
• Ability to keep all company sensitive documents secure (if applicable) 
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

  

Soft Skills:

• Attention to detail including financial information
• Organizational and analytical skills
• Flexible and adaptable to a growing and changing environment
• Team player
• Ability to manage delicate matters with diplomacy

  

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy