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.
Primary Responsibilities:
- Claim Quality Rep Sr will be responsible for carrying out audit check for clinical business
- Open and supporting other line of business to learn and perform audit
- Checks and facilitate to provide accurate response to FWAE audits and connecting with Offshore/Onshore for call calibration on Job aid/SOP
- Resource to be open & flexible for shift and work environment
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
- Applicant should have RN/`BPT/ MPT/ MD/ BHMS credentials
- 2+ years of experience in FWAE Clinical Process
- Extensive work experience, possibly in multiple functions
- Knowledge of review guidelines and policies thoroughly
- Understanding of Claims Life Cycle and claim system
- Proven good verbal and written communication skills with attention to detail & Quality focused
Preferred Qualifications:
- Applicant should be CPC certified
- Experience in commercial/SIU business/ appeals/prepay
- Health Insurance knowledge, managed care experience
- Proven to act as a resource for others, Works independently
- Proven to anticipate customer needs and proactively identifies solutions
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.
Skills Required
- RN, BPT, MPT, MD, or BHMS credential
- 2+ years of experience in FWAE Clinical Process
- Extensive work experience, possibly in multiple functions
- Knowledge of review guidelines and policies
- Understanding of claims life cycle and claim systems
- Proven verbal and written communication skills with attention to detail and quality focus
- CPC certification
- Experience in commercial/SIU business, appeals, or prepay
- Health insurance knowledge and managed care experience
- Proven ability to act as a resource for others and work independently
- Proven ability to anticipate customer needs and proactively identify solutions
Optum Compensation & Benefits Highlights
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Healthcare Strength — Health coverage offers copay and HSA medical options with dental, vision, company‑paid life and disability, and free or low‑cost virtual visits. Feedback suggests the offering is comprehensive and competitive on paper.
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Parental & Family Support — Time off and family supports include PTO, eight paid holidays plus a floating day, six weeks paid parental leave, up to two weeks paid caregiver leave, Bright Horizons back‑up care, and adoption assistance up to $10,000. Feedback suggests these resources are meaningful for caregivers and family needs.
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Retirement Support — Savings programs include a 401(k) with employer match (after one year, vesting after two) and a 10%‑discount Employee Stock Purchase Plan. These programs bolster long‑term financial security when combined with other savings resources.
Optum Insights
What We Do
Optum, part of the UnitedHealth Group family of businesses, 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. At Optum, we support your well-being with an understanding team, extensive benefits and rewarding opportunities. By joining us, you’ll have the resources to drive system transformation while we help you take care of your future. We recognize the power of connection to drive change, improve efficiency and make a difference in health care. Join a team where your skills and ideas can make an impact and where collaboration is key to creating technology that produces healthier outcomes.
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Optum Offices
Hybrid Workspace
Employees engage in a combination of remote and on-site work.
Optum has three workplace models that balance the needs of the business and the responsibilities of each role. These models, core on‑site (5 days/week), hybrid (4 days/week) and telecommute or fully remote, vary by country, role and location.
