Enroll Quality Analyst

Responsibilities

• Conduct research and audits to ensure enrollment, disenrollment, plan changes, and reconciliation activities are accurately processed.
• Interact with Compliance teams to verify that member enrollment data meets CMS standards.
• Assist with internal and external audits to ensure procedural standards are consistently followed.
• Provide feedback to reduce errors, improve processes, and ensure quality and consistency.
• Identify and recommend training or retraining for enrollment processes to meet accuracy requirements.
• Investigate, record, resolve, and report all member complaints and grievances.
• Identify and report non-conformances related to enrollment processes to management.

Requirements

• Experience with OptumRx operational platforms.
• Expertise in OptumRx processes and operations.
• Proficiency with Windows PC applications and general computer use.

Preferred Qualifications

• Experience with GPS (Generation Policy System).
• Previous experience in quality auditing.
• Knowledge of HIPAA compliance.
• Bilingual proficiency in English and Spanish.

Benefits

• Comprehensive health plans and coverage to support physical wellness.
• Emotional support through education, tools, and resilience resources.
• Financial benefits including retirement planning support.
• Resources designed to support life balance and personal growth.

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 through a culture guided by inclusion and innovation.