Enroll Quality Analyst - Makati City

Requisition Number: 2372964
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.
The Enrollment Quality Analyst conducts the necessary research and coordination to ensure all Enrollments, Disenrollment's, Plan Changes and Reconciliation activities are accurately processed. You will conduct audits and provide feedback to reduce errors, improve processes, performance and ensure quality and consistency. There will be interaction via telephone and written correspondence with the Compliance team(s) to ensure the Enrollment Department meets and exceeds all regulatory standards. Additionally, this position will work closely with Compliance regarding coordination to HIPAA, Model Audit Rule (MAR), Healthcare Effectiveness Data and Information Set (HEDIS), and any other CMS or compliance related activities.
Primary Responsibilities:

• Interact with Compliance team members via telephone, conference meetings, or e-mail to explain and verify the Enrollment Department's member enrollment data entered into the EAM and Facets databases meet the CMS standards, from the point of member application receipt to the mailing of new member material
• Assist with internal and external audits of the Enrollment Department to ensure procedural standards are consistently adhered to by the Enrollment staff. Provide feedback to reduce errors, improve processes and performances, and ensure the quality and consistency
• Conduct necessary research and coordination as necessary for all audit / compliance related activities
• Responsible for identifying recommended training/retraining of Enrollment processes or techniques to meet accuracy requirements
• Ensure all audit reports support the overall score of the Enrollment Department and compliance strategies
• Investigate, record, resolve, maintain and report all member complaints and grievances
• Support the process of validating workflows and communication tools to best enhance Quality Assurance (QA)
• Identify, investigate, and report non-conformances related to Enrollment processes to management
• 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:

• Experience with OptumRx operational platforms
• Expertise in OptumRx processes and operations
• Proficiency with computer and Windows PC applications

Preferred Qualifications:

• GPS (Generation Policy System) experience
• Quality Auditing experience
• HIPAA compliance experience
• Bilingual in English/Spanish

Take the next step, online at: www.yourlifesbestwork.com
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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.
Optum is a drug-free workplace. © 2026 Optum Global Solutions (Philippines) Inc. All rights reserved.