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Senior Customer Service Quality / Audit Representative - Overland Park, KS

UnitedHealth Group

Overland Park, KS
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Job Details

760432 Senior Customer Service Quality Audit Representative Overland Park KS

Senior Customer Service Quality / Audit Representative - Overland Park, KS (760432)

Position Description

Energize your career with one of Healthcare’s fastest growing companies.  


You dream of a great career with a great company - where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  We live for the opportunity to make a difference and right now, we are living it up.


This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.


Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation and Performance.

The Senior Customer Service Quality / Audit Representative conducts the necessary research and coordination to ensure all Enrollments, Disenrollment's, Plan Changes and Reconciliation activities are accurately processed. You will conduct audits and provide feedback to reduce errors, improve processes, performance and ensure quality and consistency. There will be interaction via telephone and written correspondence with the Compliance team(s) to ensure the Enrollment Department meets and exceeds all regulatory standards. Additionally, this position will work closely with Compliance regarding coordination to HIPAA, Model Audit Rule (MAR), Healthcare Effectiveness Data and Information Set (HEDIS), and any other CMS or compliance related activities.

Positions in this function are responsible for all aspects of quality assurance within the Enrollment and Employer Installation job family. Conducts audits and provides feedback to reduce errors and improve processes and performance.

Additionally, this position supports development of data analytics and reporting for the entire Quality Management organization. The Quality team is required to perform audits and provide feedback to diminish errors and advance processes and performance. They also analyze, identify trends, and provide reports as necessary. The Customer Service Quality / Audit Representative assist with internal audits of the Implementation Department to ensure accuracy of benefit standards are consistently adhered to by the Implementation staff. Customer Service Quality / Audit Representative will be responsible for high level audit reporting and analysis which requires a maximum level of expertise. This position, but not limited to, requires analyst to be a subject matter expert and able to facilitate trainings.

Primary Responsibilities:

  • Interact with Compliance team members via telephone, conference meetings, or e-mail to explain and verify the Enrollment Department's member enrollment data entered into the EAM and Facets databases meet the CMS standards, from the point of member application receipt to the mailing of new member material

  • Assist with internal and external audits of the Enrollment Department to ensure procedural standards are consistently adhered to by the Enrollment staff. Provide feedback to reduce errors, improve processes and performances, and ensure the quality and consistency

  • Conduct necessary research and coordination as necessary for all audit / compliance related activities

  • Responsible for identifying recommended training/retraining of Enrollment processes or techniques to meet accuracy requirements

  • Ensure all audit reports support the overall score of the Enrollment Department and compliance strategies

  • Investigate, record, resolve, maintain and report all member complaints and grievances

  • Support the process of validating workflows and communication tools to best enhance Quality Assurance (QA)

  • Identify, investigate, and report non-conformances related to Enrollment processes to management

  • This position is required to support the Risk Based Integrated Audit (RBIA) team and will be responsible for auditing Part D projects. Specifically, the position will perform visual audits and claims testing, which determines OptumRx support of contractual performance guarantees

 Required Qualifications:

  • High School Diploma / GED or higher

  • 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools or 1+ years of Claims experience

  • 1+ years of experience using Microsoft Word (create documents) and Microsoft Excel (filter, sort and analyze data)

Preferred Qualifications:

  • Bachelor’s Degree or higher

  • 1+ years of experience in Customer Service call auditing, preferably in healthcare

  • 1+ years of experience processing medical claims

OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.

If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work.


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: healthcare, UHG, Rx, analysis, data, Medicare, Medicaid, claims, audit, auditing


Job Details

  • Contest Number760432
  • Job TitleSenior Customer Service Quality / Audit Representative - Overland Park, KS
  • Job FamilyCustomer Services
  • Business SegmentOptumRx

Job Location Information

  • Overland Park, KS
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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