Claims Quality and Audit Representative
About the position 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 Claims Quality and Audit Representative primary responsibilities are to conduct reviews during the Itemized Bill Review active claim process and provide feedback to reduce errors and improve processes and performance. 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 6:30 am - 3:30 pm MST. It may be necessary, given the business need, to work occasional overtime. We offer 4 weeks of training during normal business hours. If you are located in Mountain, Pacific, or Central Time Zone, you will have the flexibility to work remotely as you take on some tough challenges. Responsibilities • Validate / analyze claim data for accuracy utilizing job aids, claim documents, policies, and procedures • Deliver / communicate fact-based quality review determinations in objective, non-confrontational manner • Provide supporting documentation for audit findings • Maintain tracking/reporting of daily tasks • Achieve production and quality goals/metrics • Identify / communicate uncommon patterns / trends to Team Lead / Manager • Demonstrate working knowledge of product, process, systems and applications Requirements • High School Diploma / GED • Must be 18 years of age OR older • 3+ years of professional work experience / knowledge of the healthcare industry • 1+ year of telecommuter experience • Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications • Experience with Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management) • Ability to work between the hours of 6:30 am - 3:30 pm MST from Monday - Friday including the flexibility to work occasional overtime based on business need Nice-to-haves • 3+ year of medical claims and / OR auditing experience • Knowledge of insurance and / OR medical terminology • Product / process knowledge • System / application knowledge Benefits • Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution Apply tot his job