Claims Quality or Audit Representative Senior at Universal Health Group

Hyderabad, Telangana, India -

Full Time

Start Date

Immediate

Expiry Date

06 Sep, 26

Salary

0.0

Posted On

08 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Audit, FWAE Clinical Process, Claims Life Cycle, Quality Assurance, Clinical Review Guidelines, Verbal Communication, Written Communication, Attention To Detail

Industry

Hospitals and Health Care

Description

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. Primary Responsibilities: Claim Quality Rep Sr will be responsible for carrying out audit check for clinical business Open and supporting other line of business to learn and perform audit Checks and facilitate to provide accurate response to FWAE audits and connecting with Offshore/Onshore for call calibration on Job aid/SOP Resource to be open & flexible for shift and work environment Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: Applicant should have RN/`BPT/ MPT/ MD/ BHMS credentials 2+ years of experience in FWAE Clinical Process Extensive work experience, possibly in multiple functions Knowledge of review guidelines and policies thoroughly Understanding of Claims Life Cycle and claim system Proven good verbal and written communication skills with attention to detail & Quality focused Preferred Qualifications: Applicant should be CPC certified Experience in commercial/SIU business/ appeals/prepay Health Insurance knowledge, managed care experience Proven to act as a resource for others, Works independently Proven to anticipate customer needs and proactively identifies solutions 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.

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Responsibilities

The representative is responsible for performing audit checks for clinical business and supporting other lines of business with FWAE audits. They will also facilitate call calibrations with onshore and offshore teams to ensure adherence to SOPs and job aids.