Senior Claims Quality Audit Representative - San Diego, CA
About the position
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 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. As a Senior Claims Quality Audit Representative, your main task will be auditing for examiners. You will also pull reports, make corrections from the county, process claims, corrections, and research from other departments. This position is full-time, Monday - Friday, and employees are required to have flexibility to work any of our 8-hour shift schedules between our normal business hours of 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at 3131 Camino Del Rio North Suite 700, San Diego, CA 92108. Employees will be required to work some days onsite and some days from home. We offer weeks of on-the-job training, and 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 Group's Telecommuter Policy.
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
,
Implement and manage day-to-day performance of process activities related to claims research and resolution
,
Review claims, contracts, and fee schedules to identify processing, procedural, systemic, and billing errors
Requirements
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 8:00 am - 5:00 pm including the flexibility to work occasional overtime
,
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
Nice-to-haves
Ability to multi-task, including understanding multiple products and multiple levels of benefits within each product
Benefits
Health and well-being programs and services
,
Flexible work schedule and remote-friendly positions
,
Health, vision and dental benefits
,
HSA and FSA eligible plans
,
401(k) savings plan
,
Childcare benefits
,
Short-term/ long-term disability coverage
,
Basic life insurance and AD&D
,
Employee stock purchase plan
,
Home office stipend for remote employees
Apply Now
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 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. As a Senior Claims Quality Audit Representative, your main task will be auditing for examiners. You will also pull reports, make corrections from the county, process claims, corrections, and research from other departments. This position is full-time, Monday - Friday, and employees are required to have flexibility to work any of our 8-hour shift schedules between our normal business hours of 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at 3131 Camino Del Rio North Suite 700, San Diego, CA 92108. Employees will be required to work some days onsite and some days from home. We offer weeks of on-the-job training, and 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 Group's Telecommuter Policy.
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
,
Implement and manage day-to-day performance of process activities related to claims research and resolution
,
Review claims, contracts, and fee schedules to identify processing, procedural, systemic, and billing errors
Requirements
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 8:00 am - 5:00 pm including the flexibility to work occasional overtime
,
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
Nice-to-haves
Ability to multi-task, including understanding multiple products and multiple levels of benefits within each product
Benefits
Health and well-being programs and services
,
Flexible work schedule and remote-friendly positions
,
Health, vision and dental benefits
,
HSA and FSA eligible plans
,
401(k) savings plan
,
Childcare benefits
,
Short-term/ long-term disability coverage
,
Basic life insurance and AD&D
,
Employee stock purchase plan
,
Home office stipend for remote employees
Apply Now