Quality Specialist

Noida, Uttar Pradesh
Permanent
Full-time

11 hours ago

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, you'll be responsible for all aspects of quality assurance within the claims job family including conducting audits and providing feedback to reduce errors and improve processes and performance. Join us and build your career with an industry leader.Primary Responsibilities:

Review, research, investigate and audit E&I Appeals for Member, Provider and Grievance
Analyze and identify trends and provide feedback and reports to reduce errors and improve accuracy and performance
Analyze information and utilize to build recommendations to reduce errors and improve process performance
Contribute towards process improvement ideas
Create, maintain, and track reports in relation to performance
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regard to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

EligibilityTo apply to an internal job, employees must meet the following criteria:

SG 23 & 24 can apply

SG 23 will move to SG 24
SG 24 will move laterally
Performance rating in the last common review cycle of "Meets Expectations" or higher

Not be on any active CAP (Corrective Action Plan) or active disciplinary action * Time in Role Guidelines

Should have been in your current position for a minimum of 12 months, if you have not met the recommended minimum time in role, discuss your career interest with your manager and gain alignment prior to applying. And share the alignment email with respective recruiter while applying

Required Qualifications:

Candidate should be graduate.
2+ years of working experience in E&I Appeals and Grievance
Should have working experience in ETS, ATS, Unet, Cirrus
Benefit research and analysis knowledge
Intermediate or greater level of proficiency with Microsoft Excel (Ex: MS Excel - data entry, sorting/filtering, pivot tables, MS PowerPoint - create and edit presentations)

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.

UnitedHealth Group

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