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. Youll be providing a senior level of support to a fast paced, intense and high-volume claims operation where accuracy and quality are essential. Youll be rewarded and recognized... more details
If you are in San Diego, CA, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.
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 health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how its reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, youll 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.
Senior Claims Quality Audit Representative is mainly auditing for examiners. This is the biggest task. You will also pull reports, make corrections from the county, process claims, corrections and research from other depts, etc.
In this role, youll 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.
This position is full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules between our normal business hours of 8:00am 5:00pm. It may be necessary, given the business need, to work occasional overtime.
Our office is locatedat 3131 Camino Del Rio North Suite 700, San Diego, CA 92108. Employees will be required to worksome daysonsite andsome daysfrom home.
We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule. Training will be conducted onsite.
*All Telecommuters will be required to adhere to UnitedHealth Groups 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. Youll be providing a senior level of support to a fast paced, intense and high-volume claims operation where accuracy and quality are essential.
Youll 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
- 3+ years of experience in claims
- Moderate proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
- Must be proficient with Microsoft Excel (pivot tables)
- Must be 18 years of age OR older
- Ability to work full-time, Monday - Friday between 8:00am 5:00pm including the flexibility to work occasional overtime given the business need
Telecommuting Requirements:
- Reside within commutable distance of 3131 Camino Del Rio North Suite 700, San Diego, CA 92108
- 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:
- Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product
California Residents Only: The hourly range for this is $19.47 - $38.08 per hour. Pay is based on several factors including but not limited tolocal 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, youll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location, and incomedeserves 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.
#RPO
