Claims Quality Audit Manager jobs in Nevada

If you are located within Pacific Time Zone, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

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.

This position is full - time (40 hours / week), Employees are required to have flexibility to work an 8-hour shift during our normal business hours of Sunday – Saturday 8:30 AM - 5:00 PM PST (Pacific Standard Time zone). Shifts will be assigned and will not change once assigned. It may be necessary, given the business need, to work occasional overtime or weekends.

We offer 2 weeks of on-the-job training. The hours during training will be 8:30am to 5:00pm PST, Monday - Friday. Training will be conducted virtually from your home.

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

Primary Responsibilities:

• Provide expertise and support by reviewing, researching, investigating and auditing problematic claims
• Analyze and identify trends and provide feedback and reports to reduce errors and improve claims processes and performance
• Responsible for all aspects of quality assurance
• Extensive work experience with multitasking in multiple functioning processes
• To work within the established procedures
• To work independently on assigned projects and can function well within a team environment
• Ability to Cross train and learn other duties to help support departmental needs
• Mentors others and/or acts as a resource for others
• Coordinates others' activities

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 equivalent work experience
• 1 years of experience in a pharmacy claims audit role and/or analysis role in a Pharmacy Benefit Management environment (i.e. handling or investigating why claims were rejected or denied for pharmacy relates services)
• Proficiency with computers and Windows personal computer applications, which includes the ability to navigate and learn new and complex computer system applications
• Experience working in claims systems Navigator and/or RX claims conducting claim reviews and additional tasks i.e. (reviewing member history, pharmacy eligibility)
• Must be 18 years of age or older
• Ability to work an 8-hour shift during our normal business hours of Sunday – Saturday 8:30 AM - 5:00 PM PST (Pacific Standard Time zone) including the flexibility to work occasional overtime or weekends.

Telecommuting Requirements:

• Reside within Pacific Time Zone
• 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.

California, Nevada or Washington 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. 

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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