Audit Team Lead at UnitedHealth Group Canada

Boston, Massachusetts, United States -

Full Time

Start Date

Immediate

Expiry Date

01 Apr, 26

Salary

127200.0

Posted On

01 Jan, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Negotiations, Mediations, Arbitrations, Claims Platforms, Data Analysis, Problem Solving, MS Excel, PowerPoint, Medical Coding, Consultative Support, Business Requirements, Operations Management, Complex Analyses, Service Excellence, Fraud Prevention, Error Resolution

Industry

Hospitals and Health Care

Description

This position is Remote in MA. You will have the flexibility to work remotely* as you take on some tough challenges. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. 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. As part of our Recovery and Resolutions team, you'll provide consultative support to our business units and external vendor organizations. You'll handle requests, define business requirements and coordinate resolutions incorporating State/Federal regulations. Join us and build your career with an industry leader. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm EST. It may be necessary, given the business need, to work occasional overtime. We offer 8 weeks of paid training. The hours of training will be based on your schedule. Primary Responsibilities Define and document/communicate business requirements Analyze scope and resolution of medium to large size Operations Management (OM) and development requests Serve as a key resource on complex and/or critical issues and help develop innovative solutions Perform complex conceptual analyses Serve as a key resource on complex and/or critical issues and help develop innovative solutions This is a challenging role with serious impact. You'll be assisting, educating, problem-solving and resolving challenging situations to the best possible outcomes. You'll need to understand and interpret clients' needs and ensure service and delivery excellence supporting the Fraud, Waste, Abuse, and Error product suite. This involves working with a high complexity solution set and cross functional teams to proactively review, research and resolve highly escalated inquiries. 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: High School Diploma / GED or equivalent work experience Must be 18 years of age or older 2+ years of experience working in negotiations, mediations, and / or arbitrations; preferably in the health insurance business 2+ years of experience analyzing and solving problems 2+ years of experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc. Proficiency using MS Excel (data entry, sorting/filtering, pivot tables) and PowerPoint Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm EST. It may be necessary, given the business need, to work occasional overtime Preferred Qualifications: 1+ years of experience in health care claims recovery Understanding of medical coding methodologies Telecommuting Requirements: Reside within the state of Massachusetts Ability to keep all company sensitive documents secure (if applicable) Required to have a dedicated work area established that is separated from other living areas and provides information privacy Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 - $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Responsibilities

The Audit Team Lead will define and document business requirements while analyzing and resolving complex operational requests. This role involves providing consultative support and developing innovative solutions to improve health outcomes.