Claims Quality Analyst - Oldsmar, FL

UHG Oldsmar, FL

About the Job

Welcome to 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. Join us and start doing your life's best work.

The Claim Quality Analyst supports the QuEST External Audit Team throughout the on - site facilitation phase of the external audit process. Positions in this function support the preparation and administration of customer audits: including claim identification, claim pulling, file preparation, file routing, scanning, and timeliness tracking. Performs tasks in a supervised environment. Subject to frequent review by Managers.  Impact of work is at external visibility level (audit firm) and internal team level.
Primary Responsibilities
  • Coordination of on - site audits
  • Communication between internal / external partners
  • Direct contact with external vendors on site
  • Maintain reporting
  • Tracking and reconciliation of claim sample files
  • Prepare sample selections
  • Claim document preparation
  • Provide supporting documentation for audit findings

Required Qualifications
  • Bachelor's Degree (or higher) or High School Diploma / GED (or higher) with equivalent work experience
  • 2+ years of Healthcare experience
  • Intermediate proficiency with Microsoft Office (Word - create documents, Excel - create spreadsheets)
Preferred Qualifications
  • Prior experience working in a production - based environment
  • Experience utilizing the following platforms: TOPS, UNET, ISET, EDSS, IDRS, CDX, SAM, Polaris, or Cirrus
  • Experience with Adobe Acrobat (view, create, manipulate, manage files), SnagIt (capture video display and audio output), SharePoint (view, share, update shared documents), or Microsoft Access database (export data, create and run queries, search data)
Soft Skills:
  • Effective communication skills
  • Effective organizational skills
Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life’s best work.SM
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.

Keywords: UHG, UHC, healthcare, health care, claim pulling, claim document, claim identification, production environment, TOPS, UNET, ISET, EDSS, IDRS, CDX, SAM, Polaris, Cirrus