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.
Primary Responsibilities:
- Conduct eligibility verification audits and reconcile tax documents for group and member level eligibility
- Communicate regularly to build and maintain Solid relationships with RAE, inside sales, financial underwriters, customer service, and agents regarding case status and audit related issues
- Communicate decisions/analysis in a concise professional manner that non-auditing personnel will understand
- Interpret Group Policies, COCs, legislative and compliance regulations
- Maintain reporting and tracking database for assigned groups
- Be able to meet TAT and productivity goals set by management
- Maintain current knowledge and understanding of HIPAA and PHI regulations
- Takes initiative to identify and resolve issues
- 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:
- 3+ years equivalent work experience in insurance or healthcare and/or auditing enrollment or degree in a related field of study
- Experience in US calling (Voice Process)
- Knowledge of Insurance Industry and Products
- Expert level proficiency with Microsoft Office applications
- Proven solid analytical, problem solving and critical decision-making skills
- Proven ability to meet TAT and productivity goals set by management
- Proven ability to learn platforms/systems as required
Preferred Qualifications:
- Knowledge of US Tax Documents / US Taxation in an audit setting
- Knowledge of Small Business or Insurance requirements
- Maintains current knowledge and understanding of HIPAA, ACA, PHI, and PII regulations
- Understands how the risk management function supports the company's goals, mission statement, and strategic objectives, and recognizes how other departments interrelate
- Proven solid verbal and written communication and customer service skills
- Proven ability to prioritize, organize, and utilize good time management skills in a fast-paced environment
- Proven ability to work both independently and in a team
- Proven solid attention to detail
