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 role performs audit process activities related to Audit and Recovery programs. The incumbent will review production audits including but not limited to, contracts, fee schedules, coordination of benefits, client specific systems, procedural documentation associated with the assigned work. The incumbent will review ad hoc audits, client referrals and test new audits in development. The objective is to identify identifying claim overpayments from claims paid data, identify changes in data and audits and make recommendations for solutions and improved results.
Primary Responsibilities:
Review all monthly client adjustments
Make sure that reference data is legible and accurate
Learn and fully understand client systems, trending and test file processes, and the current production inventory portfolio
Identify new trends and enhancements by comparing similar adjusted audit reasons to similar production cases
Identify training opportunities within existing production cases
Create and complete lead tickets and test files for client
Review top denial reasons for training opportunities, potential rebuttals back to the client, and query enhancements
Create action plan with summary and claim details to ensure that all reporting, training and priority recommendations are delivered to Operation Management
Ensure that training is completed and feedback is received
Ensure that all needed production queries are enhanced accordingly
Other duties may apply
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:
1+ years of experience analyzing data and identifying cost saving opportunities
Basic proficiency in math and thinking analytically and strategically
Experience performing advanced analysis, formulas, data capture, charts, graphs, pivots and presentations with Microsoft Excel
Demonstrated exemplary verbal and written communication skills in English
Demonstrated ability to run and manipulate data from reporting application
Willing or ability to work 40 hours weekly from Monday to Friday during our regular business hours from 7am to 7pm (Overtime as business needs dictate)
Preferred Qualifications:
Experience with claims auditing and researching claims information (experience in healthcare billing, claims, auditing, reimbursement, or data)
Experience working with medical claims platforms
Experience in healthcare
Experience with medical claims (C&D and/or COB)
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.
