Quality Analyst

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

Challenge can often be its own reward. But why settle for just being challenged when you can also be nurtured, mentored and supported in building an impact and fast paced career? With UnitedHealth Group you can have all of the above, everyday. Join us and you'll play a key role in managing data about the physicians and specialists who are part of our provider networks. This role will put you in a team of incredibly talented technological and business professionals. You'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 6 leader. 

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Uses pertinent data and facts to identify and solve a range of problems within area of expertise.

• Prioritizes and organizes own work to meet deadlines
• Performs queries on relevant systems in order to obtain relevant information for audits
• Validates data, member data, provider data against information from claims processing or business processing systems to ensure that data/decisions are accurate
• Analyzes claims/member/provider data against applicable policies and regulations to identify potential issues
• Maintains reporting infrastructure, as appropriate (e.g., SharePoint, Access databases)
• Develops and delivers fact-based audit determinations in an objective, non-confrontational manner
• 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/communicate escalated errors/defects and ensure proper resolution, as needed (e.g., calibrations, rebuttals, appeals)
• Serves on applicable cross-organizational quality committees/work groups to identify/ communicate common quality issues, trends and patterns (e.g., Quality Council)
• Identify, communicate and implement opportunities for improving internal audit/rebuttal processes within the Quality team

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 3+ years of prior experience in a transactions-based operation
• 3+ years of experience within a matrix organization, healthcare or insurance company
• 1+ years of experience with account-based products
• 1+ years of experience with auditing

Soft Skills:

• Excellent verbal and written communication skills

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.89 to $42.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

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