Job Description

Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

At UnitedHealthcare, were 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 lifes best work.SM

The Quality Review Representative position is designed to review and validate the accuracy of claims through set and random sample selections. You will review work completed by the system and claim examiners to ensure that claim handling is done according to Policies & Procedures and provide feedback when applicable. The reviews will be completed using multiple applications, including FOX and Fastrieve, while maintaining expected strong quality and production standards. Opportunities exist to be cross - trained into other quality review roles.

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 5:00am - 10:00pm CST. It may be necessary, given the business need, to work occasional overtime.

*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

Primary Responsibilities:

• Review various types of claims (imaged / manually keyed, front - end keyed, Clearinghouse and electronic)
• Evaluate claims based on policies and procedures and provide feedback as applicable
• Make decisions considering the business, the customer, and the examiner and utilize resources to support decisions
• Strong working knowledge of all systems used by Quality Operations (FOX, AskKB, Fastrieve, etc.)
• Ability to openly discuss feedback provided when an examiner feels an appeal is warranted
• Identify and provide feedback on error trends to reduce defects and improve quality results
• Act as a resource for others

Youll 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:

• High School Diploma / GED (or higher)
• 1+ years of work experience in claim processing within UCPS/FOX (internal system)
• Experience using Microsoft Excel (creating worksheets and using simple formulas)
• Current experience in Medicare and Retirement Insurance Solutions
• Ability to work an 8 - hour shift between the hours of operation 5:00 am - 10:00 pm CST Monday through Friday

Preferred Qualifications:

• Experience with Check voiding/replacing
• Knowledge of Enrollments, Billing, (Individual and/or Employer)
• Experience with Hospital Indemnity and Medicare Supplement products

Telecommuting Requirements:

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

Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in healthcare. And we are the largest business in the nation dedicated to serving their unique health and well - being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You\'ll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our Healthcare system. Ready? It's time to do your lifes best work.SM

California, Colorado, Connecticut, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / New Jersey / New York / Washington / Rhode Island residents is $18.80 - $36.78.Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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, youll find a far-reaching choice of benefits and incentives.

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.

#RPO #YELLOW

UnitedHealth Group