Claims Quality

2 months ago

Noida, India Optum Full time

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start
**Caring. Connecting. Growing together.**

**Primary Responsibilities**:

- Provide expertise and support by reviewing, researching, investigating and auditing problematic claims
- Analyze and identify trends and provide feedback and reports to reduce errors and improve claims processes and performance
- Responsible for all aspects of quality assurance
- Perform data mining/analysis
- Identify and track errors identified during the transactional quality review process
- Routinely analyze results of quality reviews to report error trends
- Demonstrate high quality and root cause identification and analysis
- Demonstrate basic levels of Six Sigma expertise
- Manage assigned special projects to completion within target date
- Create Quality system tools/databases to capture relevant data
- Use creativity to solve problems
- Demonstrate leadership in continuous improvement
- Utilize change management to drive results
- Develop recommendations for Quality remediation plans
- Timely/accurate completion of standard quality reports
- Complete ad hoc reports as requested
- Consulting support to site/account management
- Share best practices and support team goals and objectives
- Drive consistency and efficient processes on the team
- Actively participate in quality improvement initiatives/meetings
- 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

This is a challenging role with serious impact. You'll be providing a senior level of support to a fast paced, intense and high volume claims operation where accuracy and quality are essential.

**Required Qualifications**:

- High school diploma or GED OR equivalent work experience
- 3+ years of experience in claims
- At least 12 months experience of UMR claim processing
- Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product
- 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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