Claims Quality Audit Supervisor supervises and coordinates daily activities of claims quality auditors. Provides assistance in developing claims audit policies and procedures. Being a Claims Quality Audit Supervisor solves day-to-day problems and monitors the results of daily staff activities, reports critical issues and problems to the management. Typically requires a bachelor's degree. Additionally, Claims Quality Audit Supervisor typically reports to a manager. The Claims Quality Audit Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. Thorough knowledge of department processes. To be a Claims Quality Audit Supervisor typically requires 3-5 years experience in the related area as an individual contributor. (Copyright 2024 Salary.com)
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us and start doing your life’s best work.SM
The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it’s reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, you’ll be responsible for the implementation and day to day performance of process activities related to claims research and resolution. This includes the review of claims, contracts, and fee schedules to identify processing, procedural, systemic and billing errors. Join us and build your career with an industry leader.
In this role, you’ll be responsible for all aspects of quality assurance within the claims job family to ensure claims processing accuracy. The Senior Claims Quality/ Audit Representative position conducts Internal claim reviews related to Individual processor, Customer as well as Auto Adjudication. Auditors are responsible for reviewing and checking all aspects of the claim. Validating claims data against information within the claims processing system to ensure that data is accurate along with confirming the appropriate contracting and plan benefits applied. Auditor will identify processing, procedural, system and billing errors and provide feedback to reduce errors and improve processes and performance. Our purpose is to drive quality improvements and ensure accuracy of claim processing. If you are quality focused and want to assist in making improvements, Join us and build your career with an industry leader.
This position is full-time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.
We offer a week of paid training with a Team Lead and then on-the-job training with a mentor. The hours during training will be 8:00 AM - 5:00 PM from Monday - Friday.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Primary Responsibilities:
This is a challenging role with serious impact. You’ll be providing a senior level of support to a fast paced, intense and high - volume claims operation where accuracy and quality are essential.
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.
Required Qualifications:
Preferred Qualifications:
Telecommuting Requirements:
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for this is $19.47 - $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
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.
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.
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.
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