Senior Claims Quality Audit Representative - San Diego, CA

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.

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, 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.

This position is full time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am – 5:00 pm. It may be necessary, given the business need, to work occasional overtime. Employees are required to work 2-3 days onsite, and the rest will be remote.

We offer 90 days of paid on-the-job training and will be a hybrid blend. The hours of the training will be aligned with your schedule. 

If you are within commutable distance to the office 3131 Camino Del Rio North Suite 700, 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.

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

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 equivalent work experience
• Must be 18 years of age OR older
• 3 years of experience in healthcare billing 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)
• 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 
• 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

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

   
The hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. 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.

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.

#RPO 

Salary : $20 - $39