You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

At UnitedHealthcare , we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life’s best work. SM

The Claims Quality Analyst Senior supports the UHG Appeal & Grievance External Audit team in its support of A&G external audits. Positions in this function support the preparation and administration of A&G external audits, focusing on external audit appeal file compilation and executing exam corrective action plan (CAP) focused reviews. Performs tasks in a supervised environment with work product subject to frequent review. Impact of work is at internal business partner and external audit level. Exciting opportunity for an analytical, diplomatic and energetic individual to apply appeal and grievance process knowledge in a critical external audit forum.

This position is full-time (40 hours / week), Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM. Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Coordinate and respond to external audit appeal sample file production requests; create and maintain audit records
• Research and analyze appeal case files and data reports; solve problems and make decisions
• Compile complex appeal external audit sample files for external audit audiences, track work in team forums
• Assess, analyze and communicate appeal process and examination risks
• Interface regularly with internal business partners; build relationships and influence without authority
• Test process improvements via focused review process to validate business partner corrective action plans
• Willingness and eagerness to learn about appeal processes in multiple business areas: Medicaid and commercial

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED (or higher)
• 2+ years of experience with Appeal & Grievance process knowledge
• Knowledge of transactional research via process knowledge and UHG systems access
• Experience with using Microsoft Word (communicate with appropriate formatting, grammar, ability to edit), Microsoft Excel (creating spreadsheets, sort and format data)
• Working knowledge of health plan contracts (COCs, SPDs, etc.); state and federal law
• Ability to work any shift between the hours of 8:00 AM - 5:00 PM

Preferred Qualifications:

• Bachelor's Degree (or higher)
• 4+ years of UHG experience
• Experience with using Adobe PDF, Microsoft SharePoint, Microsoft Teams, and Microsoft Outlook

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

• Ability to function professionally in a corporate telecommuting forum
• Effective organization skills
• Ability to manage and prioritize competing deliverables with non-negotiable deadlines
• Teams support requiring partnership and the ability to internally advocate and influence
• Exceptional communication skills (verbal, written, analytical and problem-solving skills)
• Ability to professional engage with internal and external business partners

Careers with UnitedHealthcare. Work with a Fortune 5 organization that’s serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.

California, Colorado, Connecticut, Nevada, Washington, New York, or Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / Washington / New York / Rhode Island residents is $56,300 - $110,400. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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.

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