[Hiring] Claims Auditor @UnitedHealth Group

Role Description

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

These duties are split over four Auditor positions.

• Claims Auditors are responsible for:
• Auditing of provider disputes, member denial letter requests, and daily pre-lag reports.
• Ensuring provider dispute and member denial letters are accurately handled.
• Notifying management of any compliance concerns with timeliness of claims payments.
• Reviewing and resolving HPIs and member OOP.

This position is full-time (40 hours/week) Monday - Thursday. Employees are required to work a 10-hour shift schedule during our normal business hours of 5:45am - 4:15pm PST. It may be necessary, given the business need, to work occasional overtime.

We offer on-the-job training aligned to your schedule.

Primary Responsibilities:

• Reviews provider disputes and letters for assigned region(s) on a daily basis for accuracy to ensure timeliness of acknowledgement and resolution.
• Logs errors for use in annual performance review.
• Reports errors to Claims Manager monthly.
• Monitors pre-lag reports for assigned region(s) on a daily basis for compliance with health plan mandated turnaround times.
• Ensures that Virtual Examiner edits are run each day and that the edits are accurately applied according to SCPMCS and Client guidelines.
• Reviews various check run reports.
• Reviews and processes Fax Backs.
• Works claim notes sent via email from BN team.
• Reviews Auditor pre-lag reports and sends compliance issues to Lead Claim Auditor.
• Reviews and processes various daily/weekly reports for assigned IPA.
• Acts as backup for fellow Claims Auditor.
• Other duties as assigned.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Qualifications

• High School Diploma/GED
• Must be 18 years of age OR older
• Worked or is currently working as a contractor placed at UHG or one of its subsidiaries or affiliates
• 3+ years of experience in managed care claims processing
• Knowledge of HCFA, Medi-Cal and HMO claims payment regulation
• Experience with computers and Windows based programs including Microsoft Word and Microsoft Excel
• Ability to work full-time (40 hours/week) Monday - Thursday. Employees are required to work a 10-hour shift schedule during our normal business hours of 5:45am - 4:15pm PST. It may be necessary, given the business need, to work occasional overtime

Requirements

• Claims auditing experience

Telecommuting Requirements

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills

• Ability to communicate effectively, verbally and in written form
• Ability to achieve collaborative problem solving among Claims and Eligibility Staff and with other SCPMCS departments and Health Plan

Benefits

• Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
• In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• The salary for this role will range from $18 - $32 hourly based on full-time employment.

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.