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 all aspects of quality assurance within the claims job family. That includes assisting, educating, problem-solving and resolving challenging situations to the best possible outcomes. Join us and build your career with the industry leader. This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 7:00pm EST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime. Employees are required to work some days onsite and some days at home. We offer 4 weeks of on-the-job training. The hours of the training will be based on schedule or will be discussed on your first day of employment. If you are within commutable distance to the office at 5130 Sunforest Dr. Tampa, FL, 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:
- Review, research, investigate and audit claims and provide feedback to team members on audit results
- Analyze and identify trends and provide feedback and reports to reduce errors and improve claims processes and performance
- Analyze and use information to build recommendations to reduce errors and improve process performance
- Create, maintain and track reports in relation to performance
This is a challenging role with serious impact. You'll be providing a senior level of support and subject matter expertise within a fast paced, intense and high-volume claims operation where accuracy and quality are essential.
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
- 2+ years of experience analyzing and solving customer problems in an office setting
- 3+ years of working experience in claims processing or quality
- 3+ years of experience utilizing claims platforms such as UNET, NICE, Pulse, COSMOS, FACETS, and/or Diamond
- Intermediate level of MS Excel and PowerPoint
- Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 7:00pm EST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime. Employees are required to work some days onsite and some days at home
Preferred Qualifications
- Knowledge of CPT, ICD-10, DRG, HCPCS coding procedures
- Project coordination/management experience regarding claims payment and healthcare projects
- Process improvement experience
- Knowledge of Medicare/Medicaid
- Health plan claims experience
Telecommuting Requirements:
- Reside within commutable distance to the office at 5130 Sunforest Dr. Tampa, FL
- 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
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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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