Quality Excellence Audit Representative – National Remote

UMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It’s that simple . . . and it’s that rewarding.

In providing consumer – oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.

Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast – paced and highly diversified career.

Positions in this function are responsible for ensuring the quality and accuracy of operations within the Client Operations Support team.

This position is full-time, Monday – Friday. Employees are required to work during our normal business hours of 8:00am – 5:00pm CST. It may be necessary, given the business need, to work occasional overtime or weekends.

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

 

Primary Responsibilities:

The role involves auditing, reporting, and collaborating with various teams to maintain high standards of service delivery along with these key functions:

• Positions in this function are responsible for all aspects of quality assurance, including the following:
  • Audit Activity Log Entries: Regularly review and audit activity log entries to ensure accuracy and compliance with established standards
  • Audit HPDB Against Medical Install: Conduct audits of the HPDB (Health Plan Database) to verify consistency and accuracy against medical installation documents
  • Report OSM Inventory Turnaround Times: Monitor and report on the turnaround times for OSM (Operational Service Management) inventory to ensure timely processing and resolution
• Collaborate with Training Team: Work closely with the training team to identify areas for improvement and provide feedback to enhance training programs and materials
• Ability to thrive in a changing environment
• Provide clear and concise written feedback to OSMs regarding identified errors
• Works independently to manage own tasks and applies knowledge/skills to determine audit results

 

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 Customer Service experience analyzing and solving customer’s problems
• 1+ years of experience reading Medical Plan documents with full understanding of HRA, HSA, PPO and indemnity plan benefits, deductible, coinsurance and copay and standard plan exclusions
• Basic proficiency with Windows computer applications, which includes the ability to learn new and complex computer system applications
• Ability to work Monday – Friday, during our normal business hours of 8:00am – 5:00pm CST, including the flexibility to work occasional overtime or weekends, based on the business need

 

Preferred Qualifications:

• 1+ years of experience working within cross functioning departments of UMR
• 1+ years of experience meticulously reviewing and auditing documents and data to ensure accuracy and compliance with established standards
• 1+ years of experience identifying issues, analyzing root causes, and implementing effective solutions to improve processes and outcomes
• 1+ years of experience with Microsoft Excel (creating basic formulas, creating and managing pivot tables)
• 1+ years of experience with Microsoft Word (creating and editing documents)
• 1+ years of experience with Microsoft Outlook (creating and sending emails)

 

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 interpersonal skills, both individually and within team settings
• Exceptional written, verbal, and business communication skills
• Demonstrates proven outstanding research and analytical skills
• Skilled at thriving in a goal-oriented production environment
• Proficient in multitasking, including understanding various products and their respective benefits at multiple levels

 

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

 

The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. 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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

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