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Senior Claims Quality Audit Representative - National Remote - 2220014

UnitedHealth Group

UnitedHealth Group

Quality Assurance
Dallas, TX, USA · Tampa, FL, USA · Phoenix, AZ, USA · Minneapolis, MN, USA · Hartford, CT, USA
Posted on Monday, June 10, 2024

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

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us and start doing your life’s best work.SM

The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it’s reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, you’ll be responsible for the implementation and day to day performance of process activities related to claims research and resolution. This includes the review of claims, contracts, and fee schedules to identify processing, procedural, systemic and billing errors. Join us and build your career with an industry leader.

In this role, you’ll be responsible for all aspects of quality assurance within the claims job family to ensure claims processing accuracy. The Senior Claims Quality/ Audit Representative position conducts Internal claim reviews related to Individual processor, Customer as well as Auto Adjudication. Auditors are responsible for reviewing and checking all aspects of the claim. Validating claims data against information within the claims processing system to ensure that data is accurate along with confirming the appropriate contracting and plan benefits applied. Auditor will identify processing, procedural, system and billing errors and provide feedback to reduce errors and improve processes and performance. Our purpose is to drive quality improvements and ensure accuracy of claim processing. If you are quality focused and want to assist in making improvements, Join us and build your career with an industry leader.

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 6:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer a week of paid training with a Team Lead and then on-the-job training with a mentor. The hours during training will be 8:00 AM – 5:00 PM from Monday – Friday.

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

Primary Responsibilities:

  • Provide expertise and support by reviewing, researching, investigating and auditing problematic claims
  • Analyze and identify trends and provide feedback and reports to reduce errors and improve claims processes and performance
  • Responsible for all aspects of quality assurance

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 equivalent work experience
  • Must be 18 years of age OR older
  • 1+ years of experience in a quality assurance/auditing environment within healthcare insurance industry
  • 1+ years of experience with claims processing (medical or dental)
  • Current experience working with GEHA members
  • Experience in working with Microsoft applications, including Microsoft Word (basic copying and pasting into a Word document) and Microsoft Excel (updating spreadsheets)
  • Ability to work any 8-hour shift between the hours of 6:00 AM – 5:00 PM local time from Monday – Friday including the flexibility to work occasional overtime and weekends based on business need

Preferred Qualifications:

  • Minimum of 1+ years of experience with processing (medical / vendor) claims on the UMR Claims Processing System and completion of 10 buckets of zero check processing
  • 1+ years of CPS medical claim processing experience within UMR line of business (UMR is UnitedHealthcare’s third-party administrator (TPA) solution and candidate must be an employee of UMR specifically to have experience with the UMR claims system)

Telecommuting Requirements:

  • 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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for this is $19.47 – $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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.