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.

The Customer Service Quality / Audit Representative Senior (CSQ Audit Rep) supports the Optum Care East Region Quality and Audit team through data collection, report creation, and case audits. This position will also serve as a liaison for new hire staff to ensure successful onboarding and access to required platforms and applications.

This position is full time, Monday - Friday. Employees are required to have flexibility to work our normal business hours of 8:00 AM - 4:30 PM EST. The work hours will be in Eastern Standard Time.

We offer 2 - 3 weeks of paid training. The hours during training will be 8:00 AM - 4:30 PM EST from Monday - Friday.

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

Primary Responsibilities:

• Management of phones, fax, and team email

• Directing communications to the correct department / individual

• Managing calls from members and providers

• Providing case data to health plans for appeals or overturns

• Completing non - clinical case and call audits

• Daily report generation for Affordability and Quality metrics

• Obtaining clinical documentation from EMR

• Ordering staff equipment

• Completing secure requests for system access

• Providing onboarding services and orientation for new staff with supervision

• Gathering system data for focused audits

• Troubleshooting with IT for staff access issues

• Collaboration with development of non - clinical process documents

• Review and completion of regulatory reports

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

• Must be 18 years of age OR older

• 2+ years of administrative support experience

• Ability to toggle between multiple IT systems and platforms

• Ability to prioritize, plan, and manage multiple tasks / demands simultaneously

• Knowledge of Microsoft Office products including Microsoft Word, Microsoft Excel, and Microsoft Outlook

• Ability to work any shift between the hours of 8:00 AM - 4:30 PM EST from Monday - Friday

Preferred Qualifications:

• 2+ years of experience in a medical clinical OR hospital environment

• Certified Medical Assistant training OR certification

• Experience with peer review OR quality auditing

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy

• 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:

• Excellent organization skills and customer service skills to include verbal and written communication

• Demonstrate a high degree of professionalism to always include personal conduct and appearance

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $19.47 - $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: _ _This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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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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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