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:
- Ability to handle escalated calls/meetings directly with Customers, Stakeholders, etc., and provides resolution at the earliest
- Be sensitive and aware of the Organizational priorities towards Change & Innovation and Cost Optimization
- Driving Cost Reduction agenda in the processes with Automation Opportunities, Productivity Enhancement Opportunities and Cross utilization of resources
- Takes initiative to understand the process and keeps himself updated on the important changes in the business and the Healthcare industry
- Maintain data accuracy for the tasks assigned and respond within timelines defined/agreed
- Build systems, controls to ensure no escalations and is prompt in responding to escalations
- Own primary responsibility for the fulfillment of audit (internal and external) requests, as needed
- Forecast capacity planning by analyzing work volume patterns and aligning workforce allocation accordingly
- Should be a quick learner and able to perform accordingly to meet the SLAs
- Collaborate with team members on special projects, as needed
- 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 regard 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:
- 5+ years of working experience in US Healthcare on Behavioral Health claim adjudication / Audit
- Data-Driven Quality Assurance, Innovation and Process Optimization
- Good understanding of Six Sigma methodology
- Logical and Analytical Ability
- Proven ability to handle multiple tasks
- Lean certified preferrable
- Probing skills
- Solid verbal and written communication skills
- Solid US healthcare knowledge, especially on the behavioral health claims (Copay, Coins, Deductible, Coordination of benefit, out of pocket, in network/ out of network, CPT/HCPC Code etc.)
- Good understanding of Quality metrics and Audit sample strategies
- Good knowledge of root cause analysis techniques and tools used for problem-solving
- Excellent proficiency in using MS Excel and PowerPoint
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
- 5+ years of working experience in US Healthcare on Behavioral Health claim adjudication / Audit
- Data-Driven Quality Assurance, Innovation and Process Optimization
- Good understanding of Six Sigma methodology
- Logical and Analytical Ability
- Proven ability to handle multiple tasks
- Lean certified
- Solid verbal and written communication skills
- Solid US healthcare knowledge
- Good understanding of Quality metrics and Audit sample strategies
- Good knowledge of root cause analysis techniques
- Excellent proficiency in using MS Excel and PowerPoint
Optum Compensation & Benefits Highlights
-
Healthcare Strength — Health coverage offers multiple plan types with employer HSA contributions, in‑network preventive care at 100%, and included 24/7 virtual visits, alongside dental and vision options. This breadth allows predictable copay choices or tax‑advantaged HSA designs to fit different usage needs.
-
Retirement Support — Retirement programs include a 401(k) with employer match eligibility and full vesting over time plus an Employee Stock Purchase Plan at a discount. Together these elements support long‑term savings and ownership.
-
Parental & Family Support — Family supports include six weeks paid parental leave, paid caregiver leave, adoption assistance, and subsidized Bright Horizons back‑up care. Emotional well‑being resources like a premium Calm subscription and a 24/7 EAP complement these supports.
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.
Gallery
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.
