Quality / Audit Representative - National Remote

Description

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

This is an excellent opportunity to use your interpersonal skills in a role where you would have room for advancement while positively impacting our customer service. Make a smart career move and apply today.

This position is full - time (40 hours / week). Employees are required to work our normal business hours of 8:00 AM - 5:00 PM (candidate's time zone) including the flexibility to work occasional overtime based on business need. We offer 4 - 6 weeks of training. Training will be conducted virtually from your home.

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

Primary Responsibilities:

• Analyze information and utilize to build recommendations to reduce errors and improve process performance
• Interact with the leadership group to aid in overall staff development
• Assist in queue when required
• Assist Learning and Delivery with training initiatives
• Responsible for quality control on claim and POS transactions
• Responsible for tracking the results and reporting to the appropriate department management team
• Will work closely with department management of all departments to set up metrics for quality statistics
• Responsible for all research and system transactions for all unclaimed funds, overpayments, and uncashed checks research
• Ensure that claims are properly investigated and adjudicated in accordance with the underlying policy of insurance and applicable law
• Will audit defined denials, over the limit claims as well as random audits of the claim department
• Perform random audits of the POS department to ensure that quality metrics are met within that department
• Develop quality measurement metrics along with reporting to appropriate department

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)
• 3+ years of health insurance claims OR quality assurance experience in the individual health insurance industry
• Experience with commercial (HMO / PPO) products
• Experience with using Microsoft Word (create, edit, save documents)
• Experience with using Microsoft Excel (create, edit, sort, and filter spreadsheets and pivot tables)
• Ability to work any shift between the hours of 8:00 AM - 5:00 PM (candidate's time zone) including the flexibility to work occasional overtime based on business need

Preferred Qualifications:

• Auditing certification
• Experience with HIPAA

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

Careers at UnitedHealthcare Employer & Individual . We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life’s best work. SM

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 $16.00 - $31.44. 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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