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Quality Control Specialist - Remote

Company: Unitedhealth Group
Location: Hartford
Posted on: November 18, 2021

Job Description:

Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SMEnsure that claims are properly investigated and adjudicated in accordance with the underlying policy of insurance and applicable law. Will audit This position will be responsible for quality control on claim and POS transactions. This position will perform the audit function of all of the above. Additionally, this position will be responsible for tracking the results and reporting to the appropriate department management team. Will work closely with department management of all departments to set up metrics for quality statistics. Responsible for all research and system transactions for all unclaimed funds, overpayments, and uncashed checks research. Defined denials, over the limit claims as well as random audits of the claim department. Perform random audits of the POS department to ensure that quality metrics are met within that department. Develop quality measurement metrics along with reporting to appropriate department. This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours of 8:00am 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends. *All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.Primary Responsibilities:

Perform audit function of defined claim denials, payments and random audits for the Claims Department to ensure all claims are properly handled in accordance with the applicable policy of insurance and state laws. Performs audit function of POS transactions to ensure quality metrics are met and all changes, refunds/payments are accurately processed. Maintain statistics on result of all audits and develop reporting to appropriate department management teams.. Refers as necessary to other company departments documentation regarding quality arising from their area for corrective action and resolution.Process all voids/reissues for returned checks/unclaimed funds/ and uncashed checks.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)2 + years of experience in claim adjudication/reviews and customer service in the Healthcare Industry 2 + years of Auditing claims experience in the Healthcare IndustryMicrosoft Office including Microsoft Word (create correspondence and work within templates), Microsoft Excel (ability to sort, filter, and create simple spreadsheets), and Microsoft Outlook (email and calendar management)Preferred Qualifications:
Associates Degree (or higher)Telecommuting Requirements:
Required to have a dedicated work area established that is separated from other living areas and provides information privacyAbility 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 serviceUnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at Learn how Teresa, a Senior Quality Analyst,works withmilitary veterans and ensures they receive the best benefits and experience possible.Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your lifes best work.SMColorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $15.00 - $25.19. The salary range for Connecticut / Nevada residents is $15.77 - $27.79. 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 incentivesDiversity 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.Keywords: UHG, claims, customer service, audits, reviews, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPOby Jobble

Keywords: Unitedhealth Group, Hartford , Quality Control Specialist - Remote, Other , Hartford, Connecticut

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