We are looking for an immediate joiner who should have relevant exposure to Investigations Process with evidence gathering through fact finding and analysis.
Primary Responsibilities:
- Manage administrative intake of members
- Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers
- Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
- Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review
- Handle resolution/inquiries from members and/or providers
- 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
This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. You also must be able to work a flexible schedule that includes evening hours.
Required Qualifications:
- Any other undergraduates or Postgraduates can apply (Except Medical Science and Life Science graduates)
- Knowledge of (HIPAA) laws pertaining to confidentiality of protected health information
- Demonstrated ability to identify documentation and medical record form(s) and make independent decisions within the scope of one's job responsibilities
- Demonstrated ability to work in a team environment and to collaborate with a variety of professionals
- Demonstrated ability to work occasional off-hours schedules as required
- Proven extremely well versed with MS Office tools (Excel, Word and PowerPoint)
- Proven good data analytical skills combined with excellent communication skills
- Proven detail oriented and ability to be self-motivated to complete duties in a timely manner
- Proven attention to detail with solid organizational skills
- Proven basic analytical skills
Preferred Qualification:
- Experience in healthcare domain
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.
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What We Do
We’re the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare. We’re a global organization that’s evolving health care so everyone can have the opportunity to live their healthiest life. With our hands across all aspects of health, we'll provide you with a rewarding career that enables you to grow in the directions that best fit your passions. This is your opportunity to be part of a team that’s dedicated to Caring. Connecting. Growing together.
Our global technology team consists of more than 30,000 innovators from around the world passionate about using technology to improve the lives of people and communities. We are modernizing the health care system through modern analytics, comprehensive clinical expertise, innovative technologies and extensive experience in improving operational and clinical performance.
As part of our team, you will be provided opportunities to channel your curiosity into initiative, working alongside distinguished engineers and developers pursuing innovations that improve the health care experience for everyone. We encourage you to dive in, explore and ask questions about creative ways to use technology to help make the health care system work like an actual system.
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Employees engage in a combination of remote and on-site work.
Optum has three workplace models that balance the needs of the business, the responsibilities of a job, and your preference for more flexibility. These models are core on-site 5 days/week, hybrid 3 day/s week and telecommute or fully remote.