Claims Auditor Consultant - National Remote

Description

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. 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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work. SM

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

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

Primary Responsibilities:

• Uses pertinent data and facts to identify and solve a range of problems within area of expertise, on behalf of claim operations.
• Investigates non-standard requests and problems, with some assistance from others.
• Prioritizes and organizes own work to meet deadlines.
• Provides explanations and information to others on topics within area of expertise.
• Respond to customer/account audit support and requests within 24 hours
• Partner with other departments to resolve consumer / account holder and client requests, timely and accurately.
• Answer questions and resolve issues including escalated issues for consumer / account holders and clients timely and accurately.
• Update and maintain accurate issues / CAP logs as needed to track remediation efforts
• Create, utilize and follow P&P’s daily to complete work.
• Respond to work direction from outside the team and follow through on requests in a timely manner.
• Share information across team members to increase overall team knowledge and understanding of concepts, and to ensure consistent application.
• Create and utilize standard templates to ensure consistency when responding to requests.
• Confirm understanding of CMS & state protocols impacting claim operations to ensure ability to identify issues during the pre-audit sample prep including the ability to accurately identify claims and membership specific to the state/customer audit scope requirements subjected to the audit
• Maintain detailed knowledge of claim operations, p&p’s, mandates, exceptions, customer specific P&P’s pertinent to the specific Health Plan contracts
• Act as a technical resource to others in own function.
• Anticipate customer needs and proactively identifies solutions.
• Solves complex problems on own; proactively identifies new solutions to problems.
• Plans, prioritizes, organizes and completes work to meet established objectives.
• Demonstrates understanding of data elements within the assigned claims platforms –
• Quality assurance of data universes – ability to identify data discrepancies and the solution to arrive at accurate data including the ability to accurately identify claims and membership specific to the state / customer audit scope requirements subjected to the audit
• Conducts current state analysis to gather current business, functional and non-functional requirements and constraints (i.e., "as - is" state)
• Define desired future state requirements based on input from all applicable stakeholders
• Identify the business impact of system / application changes, using appropriate tools as needed
• Interacting with multiple states, partnerships with UHC and Optum Ops teams as well as the Ops Claims C&S BA's
• Support Internal Focus Audits requiring detailed end to end claim review ensuring the validity of internal claims processing

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) OR equivalent work experience
• 2+ years of experience utilizing claims platforms such as Optum Care Facets and Xcelys
• 2+ years of Healthcare experience
• 1+ years of experience within a matrix organization, healthcare or insurance company
• Ability to travel up to 10% of the time
• Ability to work our normal business hours of 8:00am to 5:00pm, Monday - Friday

Preferred Qualifications:

• Bachelor’s Degree (or higher)

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:

• Interpersonal Skills
• Decision Making
• Oral & Written Communication
• Accountability
• Problem Solving
• Flexibility
• Attention to Detail
• Self - Starter
• Project Management Skills

Careers with Optum . Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, Washington or New York City Residents Only: The salary range for California / Colorado / Connecticut / Nevada / Washington / New York City residents is $32.60 - $63.99.Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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.

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