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Data Mining

1 month ago

PR United States Optum Full time
Job Description

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 role performs audit process activities related to Audit and Recovery programs. The incumbent will review production audits including but not limited to, contracts, fee schedules, coordination of benefits, client specific systems, procedural documentation associated with the assigned work. The incumbent will review ad hoc audits, client referrals and test new audits in development.  The objective is to identify identifying claim overpayments from claims paid data, identify changes in data and audits and make recommendations for solutions and improved results.

Primary Responsibilities:

  • Audit paid claims data to identify overpayments
  • Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
  • Investigate and resolve overpayments on all claims types, as well as assist in resolution for health plans, commercial customers, and government entities as needed
  • Initiate phone calls to providers, employer groups, and other insurance companies to gather pertinent claim information, such as verification of billed charges, confirmation of services received, and coordination of benefits information
  • Work directly with other departments to enhance and refine assigned inventory to maximize value
  • Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
  • Use pertinent data and facts to identify and solve a range of problems within area of expertise
  • Generally work is self-directed and not prescribed
  • Works with less structured, more complex issues
  • Serves as a resource to others
  • Other duties may apply

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:

  • 1+ years of experience analyzing data and identifying cost saving opportunities OR relevant college courses including economics, statistics, data science, or finance
  • Knowledge and understanding of basic customer service skills including phone and email etiquette
  • Basic proficiency in math and thinking analytically and strategically
  • Intermediate level proficiency with Microsoft Excel (Sort, filtering, summing, formulas, formatting)
  • Demonstrated exemplary verbal and written communication skills in English
  • Willing or ability to work 40 hours weekly from Monday to Friday during our regular business hours from 7am to 7pm (Overtime as business needs dictate)

Preferred Qualifications: 

  • Experience with claims auditing and researching claims information (experience in healthcare billing, claims, auditing, reimbursement, or data)
  • Experience in healthcare
  • Experience with medical claims (C&D and/or COB)
  • Leadership experience

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.