Claims Quality Audit Representative 

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

The Claims Quality Audit Representative reviews and audits claims in IKA Systems for accuracy and appropriateness, in regard to data entry of member information, provider information and claims coding. 

 Primary Responsibilities:

  • Reviews claims for data entry accuracy
  • Understands, interprets and applies business policies and procedures related to claims, auditing and data entry
  • Analyzes data to identify error trends and reports results
  • Maintains current knowledge of CMS and HIPPA regulations
  • Complies with deadlines to ensure audit cycles are completed and reported timely 
  • Performs all other related duties as assigned

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 or GED 
  • 2+ years of health care claims processing experience 
  • Medical terminology, 10-key and computer literacy
  • Proficient with CMS 1500 and UB92 claim forms
  • Exceptional ability to organize, prioritize and communicate effectively
  • Knowledge of claims examination concepts, practices and rules, ICD and CPT coding
  • Utilize experience, knowledge and judgment to plan, accomplish goals and effectively solve problems
  • Performs a variety of tasks that may require a limited degree of creativity and latitude

Preferred Qualifications:

  • Knowledge of enterprise-wide claims management software
  • Knowledge of IKA claim and DocDNA claim systems

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California/Colorado/Connecticut/Nevada/New Jersey/New York/Rhode Island/Washington residents is $18.80 to $36.78. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.