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Job Details

Senior Claims Quality Audit Representative


Quality Assurance Manager


Noida, Uttar Pradesh, India

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.

Primary Responsibilities:

  • Carry out audit check for clinical business
  • Open and supporting other line of business to learn and perform audit
  • Checks and facilitate to provide accurate response to FWAE audits and Connecting with Offshore/Onshore for call calibration on Job aid/SOP
  • Resource to be open & flexible for shift and work environment
  • 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:

  • RN credential
  • 18+ months of experience in FWAE Clinical Process
  • Extensive work experience, possibly in multiple functions
  • Knowledge of review guidelines and policies thoroughly
  • Understanding of Claims Life Cycle and claim system
  • Proven good verbal and written communication skills with attention to detail & Quality focused

Preferred Qualifications:

  • CPC certifications
  • Health Insurance knowledge, managed care experience preferred
  • Proven ability to act as a resource for others, works independently
  • Proven ability anticipate customer needs and proactively identifies solutions

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.