Enrollment or Quality Audit Representative

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.
Working in Operations at UnitedHealth Group is 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.

The Senior Enrollment/Quality Audit Representative will be responsible for all aspects of quality assurance within the Enrollment & Employer Installation division. The Representative performs audits and provides feedback to diminish errors and advance processes and performance. When you work in Operations at UnitedHealth Group, you can help improve the efficiency and usability of a system that's going to change the face of health care. If it sounds too good to be true, consider this: Through our family of businesses and a lot of inspired individuals, we're building a high-performance structure that works better for more people in more ways.

**Primary Responsibilities**:

- Review completed projects for accurate implementation based on requests received and applied logic of RxCLAIM
- Perform test claims (as applicable) and document results to ensure requests were completed accurately in the system
- Perform root cause analysis of errors identified (if applicable)
- Assess and communicate financial impact of the errors identified Operations (if applicable)
- Validate audit findings with affected parties and confirm corrected (if applicable)
- Recommend solutions to mitigate/fix the errors noted and review them with affected parties for an agreed upon approach, as appropriate
- Document work performed and audit results based on pre-determined standards and guidelines
- User Acceptance Testing (UAT) is preformed to ensure system changes and/or enhancements are properly tested and acceptable prior to implementation
- Work with Client Management to review the implemented new and maintain existing benefits and client pricing in the pharmacy claim adjudication system
- Ensure timely communication of any issues and/or information needed to complete a plan request
- Run queries out of the RxCLAIM adjudication system to secure all necessary information to implement plan requests
- Maintain acceptable and appropriate quality levels and production turnaround times
- Adhere to all documentation standards within the department
- Assist with the development of process improvements for the department
- Research and respond to all claims processing inquiries from Client
- Applies knowledge/skills to complex activities
- Often acts as a technical resource to others in own function
- Anticipates customer needs and proactively identifies solutions
- Solves complex problems on own; proactively identifies new solutions to problems
- Plans, prioritizes, organizes and completes work to meet established objectives
- Acts as a facilitator to resolve conflicts on team; seen as key team member on project teams spanning more than own function
- 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**:

- Bachelor's degree
- Microsoft Office proficiency Word and Excel, specifically advanced Excel skills - proven ability to create Excel spreadsheet, macros, compile/analyze data for reporting
- Proven ability to work on multiple projects simultaneously
- Proven solid written and verbal skills
- Proven detail-oriented
- Proven superior organization skills
- Proven excellent analytical skills
- Proven flexible to work in night shifts

**Preferred Qualification**:

- **6 months+ experience in retail pharmacy / BPO**

**Careers with Optum. **Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health