Claims Auditor

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.    

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

These duties are split over four Auditor positions. Claims Auditors are responsible for the auditing of provider disputes, member denial letter requests, and daily prelag reports.  Responsible for ensuring provider dispute and member denial letters are accurately handled.  Responsible for notifying management of any compliance concerns with timeliness of claims payments. Reviewing and resolving HPIs and member OOP.

This position is full-time (40 hours/week) Monday - Thursday. Employees are required to work a 10-hour shift schedule during our normal business hours of 5:45am - 4:15pm PST. It may be necessary, given the business need, to work occasional overtime. 

We offer on-the-job training aligned to your schedule.

Primary Responsibilities:

• Reviews provider disputes and letters for assigned region(s) on a daily basis for accuracy to ensure timeliness of acknowledgement and resolution.  Log errors for use in annual performance review.  Reports errors to Claims Manager monthly.
• Monitors pre-lag reports for assigned region(s) on a daily basis for compliance with health plan mandated turnaround times.
• Responsible for ensuring that Virtual Examiner edits are run each day and that the edits are accurately applied according to SCPMCS and Client guidelines.
• Reviews various check run reports.
• Reviews and processes Fax Backs
• Works claim notes sent via email from BN team.
• Reviews Auditor pre-lag reports and send compliance issues to Lead Claim Auditor.
• Reviews and processes various daily/weekly reports for assigned IPA.  
• Acts as back up for fellow Claims Auditor.  
• Other duties as assigned

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
• Must be 18 years of age OR older
• Worked or is currently working as a contractor placed at UHG or one of its subsidiaries or affiliates
• 3+ years of experience in managed care claims processing
• Knowledge of HCFA, Medi-Cal and HMO claims payment regulation
• Experience with computers and Windows based programs including Microsoft Word and Microsoft Excel
• Ability to work full-time (40 hours/week) Monday - Thursday. Employees are required to work a 10-hour shift schedule during our normal business hours of 5:45am - 4:15pm PST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• Claims auditing experience

Telecommuting Requirements:

• 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 communicate effectively, verbally and in written form
• Ability to achieve collaborative problem solving among Claims and Eligibility Staff and with other SCPMCS departments and Health Plan

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $18 - $32 hourly based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.