Claims Quality Representative

Requisition Number: 2369839
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.
Results-driven Claims Recovery Analyst with experience in identifying overpayments, securing recoveries, and ensuring accurate claims processing. Skilled in analyzing medical claims, applying industry-standard coding (CPT, ICD), and maintaining high standards of productivity and quality. Solid communicator with proven ability to work independently and collaboratively in fast-paced environments.
Primary Responsibilities:

• Analyze medical claims to identify overpayments and recovery opportunities
• Validate claims accuracy using CPT-4, J-codes, and ICD diagnosis/procedure coding
• Initiate and follow up on recovery processes to secure savings
• Maintain accurate and up-to-date documentation of all recovery activities
• Communicate with internal teams and external stakeholders to resolve discrepancies
• Ensure compliance with quality standards and productivity targets
• 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 regards 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

Required Qualifications:

• Bachelor's degree (any stream)
• 1+ years of experience in medical claims processing/auditing
• Working knowledge of healthcare benefits and provider contracts
• Knowledge of Medical Claims Analysis & Auditing
• Knowledge of Overpayment Identification & Recovery
• Knowledge of CPT-4, ICD, and J-codes
• Knowledge of Claims Processing Systems (Healthcare platforms)
• Knowledge of Collections & Recovery Handling
• Proven analytical & problem-solving skills
• Proven attention to Detail & Accuracy
• Proven multitasking & time management
• Independent & Team Collaboration

Personal Attributes

• Highly detail-oriented with solid accuracy focus
• Adaptable and quick learner of new systems/tools
• Self-motivated and performance-driven
• Ability to handle multiple priorities effectively
• Continuous improvement mindset

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.