Process Expert

1 week ago

Gurgaon, 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**:

- Prevent the payment of potentially fraudulent and/or abusive claims utilizing knowledge of CPT/diagnosis codes, CMS guideline along with referring to client specific guidelines and member policies
- Adherence to state and federal compliance policies and contract compliance
- Assist the prospective team with special projects and reporting
- Coordinate with all team members and share recent process related updates
- 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**:

- Graduate
- Good comprehension skills
- Thorough knowledge on WLT ABA Payment screens
- Proper understanding of ABA Claims work flow and processing
- Claims adjudication experience on ABA platform on Outpatient and Inpatient Claims
- Knowledge of US Healthcare
- Open for NIGHT SHIFT and extended shifts
- Good knowledge on MS - Word & MS - Excel
- High Attention to detail which translates to 100% quality of work performed
- Flexibility - Ready to accommodate the working hours and working days depending on the Business Need
- Ready to support the business during peak volumes as & when needed
- Good written and verbal communication skills
- Team player
- Ability to work independently without close supervision
- Good Analytical skills. He should have the ability to understand the mistakes and correct the same
- 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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