Production Claims Auditor

UnitedHealth Group - Franklin, TN3.6

Full-time
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Energize your career with one of Healthcare’s fastest growing companies.

You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM

Primary Responsibilities:
Audit members and paid claims data
Investigate and resolve errant payments on all claims types, as well as assist in resolution for health plans, commercial customers, and government entities as needed
Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
Initiate phone calls to providers, employer groups, and other insurance companies to gather pertinent claim information e.g., verification of member policies, confirmation of services received, and coordination of benefits information
Work directly with other departments to enhance and refine assigned inventory to maximize value
Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
Use pertinent data and facts to identify and solve a range of problems within area of expertise
Generally, work is self - directed and not prescribed
Works with less structured, more complex issues
Serves as a resource to others

Required Qualifications:
Bachelor's Degree or higher
1+ years of experience analyzing data and identifying cost saving opportunities (auditing and analyzing claims data) OR relevant college courses including economics, statistics, data science, finance, math, philosophy or music
Basic proficiency in math and thinking analytically and strategically
Intermediate level proficiency with Microsoft Excel (Sort, filtering, summing, formulas, formatting)
Knowledge and understanding of basic customer service skills including phone and email etiquette
Ability to work 40 hours weekly and overtime as business needs dictate

Preferred Qualifications:
Working towards an advanced degree (statistics, economics, math, philosophy, music)
2+ years of experience researching or auditing healthcare claims information
Computer proficiency in Microsoft Office including Word (create documents), Excel (data entry) and Outlook (send email / calendar utilization)
Experience in healthcare
Experience with medical claims (C & D and / or COB)

Soft Skills:
Must demonstrate exemplary verbal and written communication skills

Physical Requirements and Work Environment:
Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

Keywords: quality, auditing, reimbursement, data analysis, advanced analysis, formulas, data capture, charts, graphs, presentations, Excel