Opportunity is here


Senior Healthcare Compliance Auditor - Remote in MA - 2217768



Boston, MA, USA
Posted on Tuesday, June 18, 2024

If you are located within Massachusetts, 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.

The Senior Healthcare Compliance Auditor will work with a team on researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules.

This position is full-time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 3:30pm EST OR 8:00am – 4:30pm EST. It may be necessary, given the business need, to work occasional overtime.

We offer 3 weeks of on-the-job training. The hours of training will be aligned with your schedule.

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

Primary Responsibilities:

  • Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization.
  • Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities.
  • Investigate and pursue recoveries and payables on subrogation claims and file management.
  • Process recovery on claims.
  • 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.

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:

  • Must have the following: Certified Coder, Certified Auditor, Registered Nurse, OR Licensed Practical Nurse.
  • Intermediate skills with Microsoft Excel.
  • Experience in healthcare.
  • Must be willing to travel to different facilities (25% travel) within the state of Massachusetts.
  • Must be 18 years of age OR older
  • Ability to work full-time, Monday – Friday between 7:00am – 3:30pm EST OR 8:00am – 4:30pm EST including the flexibility to work occasional overtime and/or weekend given the business need

Preferred Qualifications:

  • 2+ years of experience with claims auditing and researching claims information.
  • 1+ years of experience analyzing data and identifying cost saving opportunities
  • 1+ years of experience with Project Management
  • Knowledge of Medicaid/Medicare Reimbursement methodologies.
  • Microsoft Access
  • Experience working with medical claims platforms.
  • Knowledge of claims processing systems and guidelines.

Telecommuting Requirements:

  • Reside within the state of Massachusetts
  • 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.

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.