Claims Quality or Audit Representative Senior

Responsibilities

• Carry out audit checks for clinical business to ensure quality and accuracy
• Support other lines of business by learning and performing necessary audits
• Facilitate accurate responses to FWAE audits
• Connect with Offshore and Onshore teams for call calibration regarding Job aids and SOPs
• Maintain flexibility regarding work shifts and environments as required by business needs

Requirements

• RN, BPT, MPT, MD, or BHMS credentials
• 2+ years of experience in FWAE Clinical Process
• Thorough knowledge of review guidelines and policies
• Strong understanding of the Claims Life Cycle and claim systems
• Proven verbal and written communication skills with high attention to detail

Preferred Qualifications

• CPC certification
• Experience in commercial, SIU business, appeals, or prepay
• Knowledge of health insurance and managed care
• Ability to work independently and act as a resource for others
• Proactive approach to anticipating customer needs and identifying solutions

Benefits

• Life: Resources and support to focus on what matters most to you
• Emotional: Tools and resources to help manage stress and build resilience
• Physical: Health plans and coverage to support wellness
• Financial: Benefits to help you plan for the future, including retirement

About the Company

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. We connect people with the care, pharmacy benefits, data, and resources they need to feel their best.