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Claims Quality Audit Representative - Remote job in Atlanta at UnitedHealth Group

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Claims Quality Audit Representative - Remote at UnitedHealth Group

Claims Quality Audit Representative - Remote

UnitedHealth Group Work From Home Full Time

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

Energize your career with one of Healthcare’s fastest growing companies.  

You dream of a great career with a great company – where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 10 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (8am - 8pm EST). It may be necessary, given the business need, to work occasional overtime.

Training will be conducted virtually from your home.

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

Primary Responsibilities:

  • Audits all systematic and manual operational processes, monitoring and assessing quality, compliance, accuracy, and effectiveness of the program
  • Performs systematic appraisal of management controls, policies, practices and operational reports
  • Investigates claims adherence to contractual agreements to validate Clinical Audit results
  • Audits all Client Contracts, ensuring all operational processes and results, monitoring and assessing adherence to all requirements
  • Identifies deficits and makes recommendations for performance improvements based on audit results
  • Analyzes large volumes of Operational data utilizing analytic skillsets and summarizes results to ensure compliance with departmental requirements and standards
  • Detects changes, identifies trends  and makes recommendations based on Operational analysis
  • Provides quality Productivity Assessment to departmental leadership and collaborates with the development of Corrective Action Plans
  • Ensures new Client implementation requirements and all contractual obligations are met
  • Presents audit reports and findings clearly and concisely, and ensures results are understood
  • Identifies audit opportunities and process improvements through quality assessment reviews
  • Support, mentor and make recommendations on how to improve quality and customer satisfaction.
  • Communicate with both clients and management on defects identified

This is a challenging role with serious impact. You’ll be providing a senior level of support to a fast paced, intense and high-volume claims operation where accuracy and quality are essential.

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 (or higher)
  • Understanding of claims processing
  • 3+ years in healthcare claims auditing
  • 1+ years experience as a Claims Resolution Coordinator Senior/ Supervisor, or equivalent prior relevant experience
  • Highly skilled in the MS Office Suite (MS Outlook (create and send emails), Word (create and edit correspondence), Excel (ability to create, edit, and sort spreadsheets), and Power Point(ability to create and edit slides)
  • Minimum of Intermediate Excel skillset, up to and including all data analytic tools such as Pivot Tables, Database Management, etc.

Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • 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:

  • Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product
  • Excellent Interpersonal skills and ability to work well independently, as well as within a team environment
  • Ability to communicate clearly and concisely through both written and verbal skills
  • Strong attention to detail and skillful in identifying anomalies in current processes and workflows
  • Professional and positive commitment to service delivery within and outside the organization
  • Must always be able to maintain professionalism and a positive attitude
  • Excellent analytical skills, and ability to summarize findings
  • Competent and confident in presenting audit reports and analysis to Clients and Leadership

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at [ Link removed ] - Click here to apply to Claims Quality Audit Representative - Remote

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. [ Link removed ] - Click here to apply to Claims Quality Audit Representative - Remote

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

Colorado Residents Only: The hourly range for Colorado residents is $15.00 to $25.19. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Healthcare, health care, Managed Care, Claims, Customer Service, Claims Recovery, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO


Recommended Skills

  • Scheduling
  • Attention To Detail
  • Auditing
  • Process Improvements (Business)
  • Reports
  • Professional Attitude
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