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Hours Full-time, Part-time
Location Tampa, FL
Tampa, Florida

About this job



Position Description:

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.

UnitedHealth Group
is working to create the Healthcare system of tomorrow and you can
help. Already Fortune 17, we are totally focused on innovation and
change.  We work a little harder. We aim a little higher. We expect more
from ourselves and each other. And at the end of the day, we're doing a
lot of good.
 
Through
our family of businesses and a lot of inspired individuals, we're
building a high-performance Healthcare system that works better for more
people in more ways than ever. Now we're looking to reinforce our team
with people who are decisive, brilliant and built for speed.  Join with
us and start doing your life’s best work.
 
The Senior Claims Quality Audit Representative
works closely with Appeals and Grievance Operations Production and
Business Process Management Team, to ensure continued improvement of
operational processes, system implementation, process automation and
reconciliation.  Identifies process gaps and suggests remediation by
systemically addressing issues that are associated with Star metrics and
the member experience.
Primary  Responsibilities:
Assists with implementation follow up tasks of projects under the direction of managementCoordinates meetings and follow up project work for receipt reconciliation activities Communicates clearly and effectively with project
team, including programmers, project leaders, business development and
other researchersPerforms detailed review, research, and investigation
on business feedback related to A&G Tool and reconciliation across
Appeals and Grievances teams.Responds to, and takes next steps as necessary for remediation. Provides comprehensive evidence and documentation of all requestsSupports ongoing A&G tool access changes.Develop skills of Appeals and Grievances process and system documentation, in addition to knowledge of reconciliation processes.Provide expertise or general claims support by
reviewing, researching, investigating, negotiating and resolving all
types of appeals and grievancesAnalyze and identify trends and provides reports as necessaryWorks independentlyMay act as a resource for othersRole is detailed oriented and requires the use of strong investigative and research toolsOrganization and strong documentation skills

Requirements

Requirements:
High School Diploma or GEDExperience
with Appeals, Grievances and/or claim processing experienceKnowledge of  HIPAA requirements and UHG documentation handling policies and proceduresExperience
with MS Word - create/update documents, Excel- create/update
spreadsheets, and proven ability to navigate internal systems and
SharePoint sites
Assets:Undergraduate Degree (or higher)Experience communicating process failures and propose remediation
Soft Skills:

Proven communication skills with the ability to quickly establish rapport and creditability.
Physical Requirements and Work Environment:
Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
Careers with UnitedHealthcare.
Let's talk about opportunity. Start with a Fortune 17 organization
that's serving more than 85 million people already and building the
industry's singular reputation for bold ideas and impeccable execution.
Now, add your energy, your passion for excellence, your near-obsession
with driving change for the better. Get the picture? UnitedHealthcare is
serving employers and individuals, states and communities, Military
families and Veterans wherever they're found across the globe. We bring
them the resources of an industry leader and a commitment to improve
their lives that's second to none. This is no small opportunity. It's
where you can do your life’s best work. 
Diversity
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, UnitedHealth Group, Appeals, Grievance, Quality, Audit, HIPAA, Claims, Senior Representative