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 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. Join us and build your career with an industry leader.
This is a challenging role with serious impact. You'll be providing a senior level of support to a fast paced, intense and high volume claims operation where accuracy and quality are essential.
Positions in this function are responsible for all aspects of quality assurance within the Claims job family. Conducts audits and provides feedback to reduce errors and improve processes and performance. *Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.
- 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
- Extensive work experience, possibly in multiple functions.
- Work does not usually require established procedures.
- Works independently.
- Mentors others.
- Acts as a resource for others.
- Coordinates others' activities.
- High school diploma / GED or higher
- 3+ years of experience in claims
- Moderate proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
- Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product
Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in healthcare. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our Healthcare system. Ready? It's time to do your life’s best work.SM
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.
Keywords: Senior, Claims, Quality, Audit, Rep