Claims Auditor Consultant - Eden Prairie, MN; Eau Claire, WI; Wauwatosa, WI; US Telecommute - Full-time / Part-time

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.

You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.(sm)

This is a quality role that supports the Optum Payment Integrity Fraud, Waste, Abuse and Error business units. This role is responsible for the determining the accuracy of the outcome of claim payment decisions after clinical review of medical record submissions.

Primary Responsibilities:

• Validate the accuracy of clinical medical record reviews and payment decisions.
• Develop and deliver fact based audit determinations.
• Serve on applicable cross-functional quality committees and work groups to identify and communicate common quality issues, trends, and patterns.

Requirements:

• High School Diploma or GED
• 2+ years of experience utilizing claims platforms such as UNET, NICE, Pulse, COSMOS, FACETS, and/or Diamond
• 1+ years of Healthcare experience
• 1+ years with MS Excel (creating, saving, formatting documents, pivot tables)
• Project Coordination/Management experience regarding claims payment and Healthcare projects
• Medical coding certification with AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management Association)

Assets:

• Undergraduate degree or higher
• Process Improvement Experience
• Six Sigma Methodology Experience (Green-Black Belt)

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

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: claims, medical claims, healthcare claims, claims processing, claims processor; office, UnitedHealth Group, Optum,  training class, customer service representative, customer service, CSR, Data Entry, adjustments, audit, quality, fraud