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. 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.

This position is responsible for reviewing, investigating, and auditing of Institutional / Facility claims.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 6:00 AM - 2:30 PM PST (Pacific Standard Time). It may be necessary, given the business need, to work occasional overtime.

We offer weeks of paid training. The hours of training will be based on your schedule or will be discussed on your first day of employment.

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

Primary Responsibilities:

• Audit claims based on contractual arrangements with providers and follow DMHC / CMS guidelines for non - contractual providers
• Provide expertise claims support by reviewing, researching, auditing, and explaining claims
• Analyze and identify trends and provides feedback and reports to reduce errors and improve claims processes and performance
• Responsible for all aspects of quality assurance
• Performs complex and extensive research, analysis and logical conclusions of paper and electronic claims
• Conducts necessary follow - up with internal departments within set timeframes to validate payment integrity related to regulatory agencies, contracts, policy, coding, and system configuration
• Acts as a department resource and gives support to Claims. Responds to Claims disputes in a professional manner
• Identify, trend, and report provider issues to management for quality improvement
• Collaborates with other departments and management to implement and reinforce policy quality standards

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
• Must be 18 years of age OR older
• 3 years of experience as a Claims Examiner with previous Medicare and HMO experience
• 1 years of Institutional claims processing experience
• Ability to interpret Health plan division of financial responsibility matrix
• Knowledge of Correct Coding Initiative, UB claim forms, and REV / CPT Coding
• Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
• Intermediate skill level with Microsoft Excel
• Ability to work any shift between the hours of 6:00 AM - 2:30 PM PST (Pacific Standard Time) from Monday - Friday including the flexibility to work occasional overtime based on business need

Preferred Qualifications:

• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume
• Ability to apply concepts of basic algebra and geometry
• Ability to comprehend, interpret, and apply provider contract language

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

Soft Skills:

• Ability to communicate effectively in written or oral format
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form
• Ability to deal with problems involving several concrete variables in standardized situations

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.

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